Surgical or non-surgical options may be sought for treatment of scoliosis.
All patients treated by Dr. Feldman receive treatment by the Schroth Method. This is a highly specific method of physical therapy that is used to treat scoliosis.
The Paley Institute Rehabilitation Department is experienced in treating a variety of complex orthopedic conditions. The Rehabilitation Department works closely with Dr. Feldman in order to provide his patients with the highest level of care. The Paley Institute Rehabilitation Department is in the process of opening a dedicated Schroth Center, where all of the therapists will be specially trained to perform this method.
Dr. Feldman's New York patients are referred to other locations that have been trained in the Schroth Method.
It is also vitally important for individuals who have scoliosis and / or wear a brace to keep their core strong. While no one method of exercise or manipulation has been proven to help prevent the progression of scoliosis, I still recommend back exercises for my patients. Physical therapy regimens such as the Schroth method have been found to be effective in maintaining core strength and increasing comfort.
Bracing has been used for generations to prevent mild to moderate cases of scoliosis from progressing. A brace is only effective in young patients with significant growth remaining. The amount of growth remaining can be determined by x-rays of the hands or the top of the pelvis. Once bracing begins, the brace often needs to be worn until growth is completed which is usually around age 14 in females and 16 in males.
- The Milwaukee Brace which comes over the neck or under the chin was widely used in the past but is now almost never used.
- The 23 hour custom made (Boston-like) scoliosis brace is very effective but must be worn for 18 hours or more and can be physically and psychologically challenging for patients.
- I often use other effective braces such as the Providence Brace which incorporates straps, are less bulky, and/or can be worn at night.
This is the most common type of surgery for scoliosis. Rods and screws are attached to vertebrae to fuse the bones together helping to straighten the spine. This procedure is only utilized for severe curves where all other treatment methods have failed. There is often no need for bracing after this surgery and patients may return to their activities in as little as one to two months.
For all of this spinal fusion patients, Dr. Feldman utilizes a specialized multilayered closure technique by a plastic surgeon in order to dramatically lower the rate of post-operative wound complications.
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Devices such as Vertical Expandable Prosthetic Titanium Rib (VEPTR) and growing rods are used to straighten the spine without fusing vertebrae. This surgery is less commonly performed and is usually utilized for very young patients with progressive scoliosis who have a great deal of growth remaining. There is currently a great deal of interest and research into these techniques as they would allow for the avoidance of fusion.
For more information, see VEPTR
Spinal tethering is a new method of fusionless surgery that aims to correct scoliosis while maintaining motion. There are two techniques of spinal tethering:
- Vertebral Body Stapling
- Screw and Cable
Vertebral body stapling involves the insertion of staples across the growth plates of the vertebrae. The staples are inserted on the side with the longer curve, which are growing faster than the opposite side. The staples inhibit growth on that one side but allow it on the opposite side, resulting in gradual straightening of the spine as the patient ages. This technique is a form of guided growth. The procedure is only effective in younger patients since it relies on patient growth.
The screw and cable technique was developed to treat patients older than 10 years of age, in which stapling is less effective. The screw and cable technique is also used for curves of a large magnitude (over 40 degrees). The technique involves the insertion of special titanium screws into the side with the longer curve, along with a flexible cable that connects the screws. The cable resists growth in the deformed direction, but allows growth in all other directions, resulting in spontaneous and complete correction as the patient grows.
A cosmetic procedure that involves the removal of a protruding rib and is at times combined with other procedures.
The treatment options for scoliosis are continuously evolving and constantly improving. The non-surgical and surgical methods used today are very different from what they used to be. Choosing the right intervention at the optimal time remains a crucial step in achieving the best possible outcome.