Conservative (non-surgical) treatment of scoliosis

What non-surgical scoliosis treatment includes

We combine methods according to age, curve type, Cobb angle, skeletal maturity and changes over time. For each stage, we define the goal and how to monitor the result.^[1]

At the consultation, I will explain which components are needed in your situation, what to monitor at home and when to arrange the next assessment.

Which scans are needed to assess scoliosis?

The main investigation is standing whole-spine radiographs in frontal and lateral views. They allow measurement of the Cobb angle and assessment of curve shape and trunk balance. Previous dated images show how the deformity is changing.^[2]

For preliminary review, send:

• existing standing whole-spine images and reports;
• previous radiographs with dates;
• age, symptoms and information about the child's growth rate;
• a description of exercises, brace use and previous treatment;
• MRI, CT or surgical discharge summaries if already available.

Additional investigations are arranged when indicated. MRI may be needed for neurological signs, an atypical course or particular planning questions; it does not replace standing images for deformity assessment.^[1]

How to send digital investigations and DICOM files

Observation: how we monitor the curve

Observation involves an agreed schedule of appointments. We compare the curve's angle and shape, shoulder and pelvic position, trunk balance and changes during growth. The frequency of follow-up imaging is determined by progression risk, avoiding unnecessary repeat examinations.^[1]

It is important to attend follow-up at the agreed time and keep all previous images. If the curve increases or symptoms change, we review the treatment plan.

Scoliosis-specific exercises

Physiotherapeutic scoliosis-specific exercises, or PSSE, focus on active self-correction, control of trunk position and applying these skills to everyday activity. One approach is the Schroth method. The programme is selected by a physiotherapist trained in scoliosis care.

A randomised study in adolescents showed a better change in Cobb angle when Schroth exercises were added to standard treatment for six months.^[4] We consider these exercises part of a combined plan; indications for bracing are assessed separately.

• Sessions with a specialist: learning the technique according to your curve type.
• Home programme: regular exercises and a clear way to check that they are performed correctly.
• Follow-up: assessment of function, how you feel and changes in the deformity.

General physical activity supports overall fitness. Sport or swimming may complement the plan but do not replace individual treatment. In the absence of specific restrictions, we agree activity so that the child can participate in everyday life.^[5]

Scoliosis bracing: when and why we prescribe it

In growing adolescents with idiopathic scoliosis, a brace can reduce the risk of curve progression. This is supported by the BrAIST study. Results are related, among other factors, to adherence to the prescribed wearing schedule.^[3]

Bracing is usually discussed for curves of approximately 25° to 45–50° during growth. These are guides: we consider curve type, progression and remaining growth, not chronological age alone.^[6]

The aim of bracing is to control progression until growth is complete. The brace type, including possible use of a Chêneau brace, is determined by the deformity. Custom manufacture, fitting checks and monitoring of correction are important.

• The number of wearing hours is prescribed for the particular brace and clinical situation.
• During growth, we check the fit and adjust the brace promptly.
• Discuss skin irritation, discomfort or difficulties with the wearing schedule with the team.
• We plan the end of bracing according to skeletal maturity and imaging changes.

Family support helps make treatment part of everyday life. The plan includes education, physical activity and practical aspects of brace wearing.

Non-surgical scoliosis treatment in adults

After growth is complete, the objectives differ: reducing pain, maintaining strength and endurance, and improving tolerance of walking and everyday activity. We separately assess trunk balance, disc health and possible nerve compression.^[7]

The plan may include adapted exercises, gradually increasing activity and treatment of the established pain cause. Medicines and injections are considered when indicated. Symptom relief and a change in the structural curve are different outcomes, assessed separately.

In an adult, a brace may serve a specific supporting or pain-control purpose. We do not automatically extrapolate bracing results in growing adolescents to adults.

When to discuss surgical correction

We review the treatment plan if deformity progresses substantially, trunk balance worsens, significant functional limitations persist or neurological problems appear. We also consider your goals: external asymmetry, mobility and everyday activity.

As a spine surgeon, I will explain when continuing non-surgical treatment is appropriate and when to discuss surgery. In my practice, I consider dynamic ASC correction for selected patients. Correction with fusion is a separate surgical alternative; I do not personally perform classical scoliosis fusion correction. The choice depends on curve type and flexibility, skeletal maturity and the extent of correction required.

Surgical treatment of scoliosis: ASC and correction with fusion

Questions about treating scoliosis without surgery

Can exercises completely straighten scoliosis?

Exercises have specific objectives: active self-correction, function and symptom control. We discuss the expected change in deformity according to age, curve type and progression. There is no universal programme that completely straightens every structural scoliosis.

Are massage or electrical stimulation enough?

We do not regard them as proven ways to limit structural scoliosis progression. If a curve is at risk of increasing, orthopaedic monitoring and a treatment plan are needed; additional procedures may serve a separate symptom-management purpose.^[1]

Does everyone need to wear a brace for 23 hours a day?

The schedule depends on the brace type, curve and remaining growth. The doctor determines the specific number of hours. It is important to follow the prescription and discuss difficulties so the team can help.

Is a photograph of the back enough to choose treatment?

A photograph may show external asymmetry. Examination and standing radiographs are needed to assess the structural curve. Send existing images and previous dated investigations.