Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed

We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.

I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.

For curves under 25 degrees in a child who is still skeletally immature, roughly before puberty (around 12 to 13 years old for girls and 14 to 15 for boys), observation is usually the right approach.

The evidence for bracing's effectiveness is described as very controversial, without solid, level-one clinical evidence that it changes outcomes, though it can be psychologically reassuring to parents and children as an intermediate step.

Once a curve reaches 40 to 45 degrees, particularly as the child approaches skeletal maturity, surgery becomes necessary since nothing else will stop the curve from continuing to worsen.

Deciding on the right time for scoliosis surgery, neither too early nor too late, is one of the most important judgements in paediatric spine surgery.