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Severity and Treatment
The severity of the scoliosis is measured by degrees of curvature, which can range from extremely slight at 5 degrees, to extremely severe at 90 degrees. Slight curves do not send up warning flares to doctors. However, Carissa Havrilko’s curve reached 71 degrees, which is a very noticeable and progressing curve.

“A 9-year-old is still growing, so chances are a five-degree curve has very little possibility statistically of getting much worse. But the problem is that I don’t know which it is going to be. I can’t guarantee you in larger degrees that [it] won’t progress or get worse,” Haynes said. In those cases, monitoring the curve is often as far as treatment goes.

“We monitor the curve as the child is growing, but most curves will stop before they get to be 25 degrees. However, if the child is still growing and the curve does reach 25 degrees, we treat it with a brace. That will stop the curve where it is, but it won’t correct it,” Renshaw said.

The problems arise when larger curves are detected. A twisting spine can cause deformity in appearance, back pain and, if extremely severe, can compress and even puncture the lungs. Braces are usually recommended for curves that are less than 50 degrees.

“We used to have these braces with a neck collar that would just go around the chest and the neckline. The ones we have now are ‘low profile braces:’ much smaller, lighter weight, and really less cumbersome because they stop below the armpits,” he said. “They just have to wear it until they finish growing at 14 to 16 years of age.”

While a brace can keep a curve from getting worse, only surgery can help straighten the spine.

“We usually recommend doing surgery to prevent the curve from worsening and to correct it as much as possible, but mainly to preclude the worse thing that is inevitable. Most people would recommend surgery when it gets into the 50 degree,” Haynes said.

Scoliosis surgery involves placing two metal rods along the back part of the spine and attaching them to various vertebrae, hooks, screws or wires.

“It does straighten the spine and that’s permanent,” Renshaw said.

Other Options
There are other venues for dealing with scoliosis as well. Chiropractors view scoliosis differently from orthopedic doctors.

“Oftentimes, people come in with complaints about other things, such as in their neck or back, and don’t even realize they have scoliosis. We go well beyond the typical generalized orthopedic test. We’re looking for the cause, to find something within spinal column itself, to see if there is what we call a bio-mechanical fixation,” explained Keith Overland, D.C., a chiropractor in Norwalk, Conn.

Overland categorizes scoliosis into two types: functional and structural. “The functional type may be based on a short leg, a muscle contraction, or some kind of muscular splinting. It may be sports-related. If someone is so dominant on one side of his or her body, it will develop a curvature. Structural scoliosis is the kind you’re born with.”

Chiropractors offer varying treatments to help alleviate pain and maintain flexibility, according to Overland, including exercises, manipulation, electrical stimulation of the muscles and braces. If the curvature is severe, Overland will refer the patient to an orthopedic surgeon for bracing.

“I refer 15 [percent] to 25 percent of my patients to pediatric orthopedists. If something is structural and beyond what is appropriate, and I can’t help them, I have no problem doing that,” he said.

But orthopedists remain skeptical about the modality or physical treatment of the disorder.

“There is no evidence that anything other than bracing will prevent the curve from progressing. The modality, things like exercises or manipulation, don’t have any value from keeping a curve from getting worse,” Haynes said. “You have to remember, since 90 percent of those kids we see will have no progression of their curves anyway, that whatever you do, it doesn’t make any difference either way. The problem comes in if you try other treatments and wait too long. For, if the curve keeps progressing in the meanwhile, you may be looking at surgery rather than a brace.”

“Bracing is effective and it does prevent further curvature,” Overland said. “All I’m saying is, when you look at a diagnosis such as scoliosis, you should look at all the treatment options. Too often, you will be directed toward one particular treatment. A medical doctor may guide someone toward the medical approach; a chiropractor just toward chiropractic. Be open to investigating a variety of treatment options, or the best combination of treatments.”

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