In adults, scoliosis can be a direct result from having scoliosis as a child/adolescent or could develop in adulthood. The most common forms of adult scoliosis are developed in adulthood with no prior history of its development in adolescence. This can be the result of degenerative changes to the spine that occur as part of the aging process, an injury, or the result of another pathology. While these issues may cause the scoliosis, once a curve reaches greater than 40 degrees gravitational forces will cause the curve to continue to progress. As the curve continues to increase, it is causing a compressive effect on the concave side of the spine and torque of the spine which causes pain that is then felt in various areas of the back and hips.
The first approach to treatment for adult scoliosis should always be non-surgical treatment. In general, patients in good health who are experiencing back pain and fatigue, are best treated with a Schroth specific therapy program. This will be effective in re-conditioning muscles and gaining a reduction of abnormal alignment and motion in the spinal column, reducing pain. In order for the exercises to be effective they must be performed on a regular basis.
For patients with more severe pain, larger curves and/or more severe misalignment or instability, the addition of the Adult LA Scoliosis brace (ALAS) can be very helpful. The ALAS brace is a less aggressive, lighter, thinner brace than the Pediatric LA Brace. It will help to realign the spine and reduce abnormal motion across the spine, as well as providing the sensation of increased support. The ALAS brace usually does not eliminate the need for Schroth therapy and exercises can often be performed while wearing the brace.
Scoliosis Progression in Adults
As an adult with scoliosis ages, the curve becomes larger and larger and tends to progress faster and faster. While there’s no easy formula that can be applied to determine exactly how much or how fast an adult’s scoliosis is going to progress, the most common pattern is that as patients get older, their curvature increases as more time goes by.
Adult scoliosis braces are mainly worn part time, rather than full time like adolescents do. Part-time wearing for adults would approximate 2 to 10 hours a day, usually during daytime hours.
If a scoliosis brace is being worn only for pain relief AND the curve is less than 40 degrees, the patient will wear it for 30 minutes to an hour to help them get out of pain, and then they’ll take the brace off and continue on with their day.
For all other cases, the brace is worn a minimum of 2 hours a day and a maximum of 10 hours/day and the goals is for both pain relief AND minimizes curve progression. For example, an adult patient whose curve is progressing at the rate of 2 degree a year and we can reduce that rate to 1⁄4 of a degree a year, over 10 years, instead of progressing 20 degrees, now it only progresses 2 degrees.
Why Doesn’t the Medical Community Usually Suggest Bracing ?
In the traditional orthopedic approach, a rigid symmetrical type brace is used. Theses brace rely predominantly on compression for effect but this protocol has been proven to have minimal effect and be more likely to cause weakness and atrophy. Therefore many physicians will claim bracing does not work whereas in truth it is that the bracing they have experienced does not work. Properly designed and made corrective adult braces like the ALAS brace can be worn as part of an effective scoliosis treatment plan and provide positive outcomes. However it must be designed properly and provided by a skilled orthotist who has experience with fitting corrective adult scoliosis braces. Often maximum benefit is achieved when combined with other forms of conservative treatment.
Scoliosis Surgery vs. Scoliosis Bracing
An interesting way to look at scoliosis braces for adults is to compare them to the results of spinal-fusion surgery. In spinal fusion, rods and screws are attached to the spine to hold the spine in a straighter alignment.
Effectively what scoliosis surgery does is brace the spine from the inside. Just as the rods and screws are holding the scoliosis, the scoliosis brace, whether using squeezing or pushing, is performing a similar function on the outside.
The goal of scoliosis surgery is to prevent progression by creating scaffolding for the spine on the inside.
Where the outcomes differ is when comparing scoliosis surgery with a ‘corrective’ brace, such as the ALAS Brace; while the ALAS brace does hold the spine in a straighter alignment just as the rods and screws would, the pushing force of a corrective brace first works to reduce the curvature and then holds that reduction.
While the goal of scoliosis surgery is to halt progression by holding the spine in place, the goal of a well-designed corrective brace is to first reduce the curvature to produce a structural change, and then to hold that reduction.
Basically, we’re doing the same thing with corrective bracing, just without all the risks and complications associated with invasive spinal-fusion surgery.
In terms of lifestyle, bracing also has more to offer as adults can remove the back brace and do what they want to do. With scoliosis surgery, whatever the outcome of surgery is is permanent; there’s no adjusting or going back. If the surgery doesn’t go well, the only option for improvement is to have more surgeries.
In contrast, if things don’t go well with adult bracing, the worst thing that happens is we revisit and adjust. We can modify or tweak the design of the brace to make it more customized to the patient’s needs, or we can add some associative rehabilitation to supplement those brace results and get a better result.
When compared with scoliosis surgery, adult bracing carries far fewer risks, offers better results, is more affordable, and protects the strength and longevity of the spine.