Scoliosis is a medical condition that is characterized by an abnormal curvature of the spine. There may be only one curve or several, and the extent and severity of the disorder can vary greatly from person to person. In many cases, where curvature is slight, the individual may not experience any symptoms and treatment is not necessary. However, patients with more pronounced curves may experience severe back pain and the curvature can even compromise the function of the heart and lungs. Scoliosis may occur at any point along the spine, and thoracic scoliosis involves curvature in the thoracic vertebrae of the chest area. Because the thoracic vertebrae are situated near the lungs, severe curvature can impede breathing, necessitating aggressive treatment.
There are numerous treatments available to address the problem of thoracic scoliosis, and the choice as to what treatment modalitie(s) to use is dependent upon many factors. In mild cases (curves are all less than 20 degrees) where the patient is asymptomatic, doctors may choose to address a stance of cautious waiting, and simply monitor the condition to ascertain whether or not it will progress sufficiently to warrant treatment. In choosing a program for a particular patient, doctors must consider such issues as whether the patient has finished growing, the severity and number of curves and the potential for continued progression, as well as the degree of urgency in terms of possible impending damage to other body systems.
Exercises, in the form of physical therapy, or simply assigned exercises for home, are often prescribed for patients with very mild thoracic scoliosis. The goal of such exercise is to strengthen the core muscles of the body, reducing strain on the back and improving posture. Physical therapy may also be used in conjunction with other treatments for moderate to severe scoliosis. Physical therapists can use a variety of treatments including the introduction of outside agents such as heat and cold therapy, electrical stimulation and traction to help improve flexibility, range of motion and strength and reduce patient discomfort.
Bracing is often prescribed for moderate to severe scoliosis as a first-line treatment, particularly in children who have not finished growing yet. Until approximately 10 years ago, the Milwaukee Brace was the commonly prescribed type of back brace. It is still used, though less commonly than other types, to attempt to halt the progression of the spinal curvature(s). A Milwaukee Brace consists of a plastic body that extends from just under the arms to the hips and encases the entire torso, as well as three bars and a neck ring. It is tightened by the use of three heavy adjustable straps, and the entire apparatus serves to hold the spine in alignment. The brace is worn at all times, except while bathing or participating in exercise.
The Boston Brace is the most commonly used type of brace to treat lumbar or thoracic scoliosis. It is much less cumbersome than the Milwaukee Brace, as it does not have a neck ring or bars. Instead, it is a one-piece plastic molded brace that encloses the torso from armpits to hips, and is adjusted with heavy Velcro straps. Like the Milwaukee Brace, doctors generally prescribe that it be worn at all times. However, many patients find this brace preferable because it is lighter and more easily hidden under clothing.
The Spinecor Brace is a relatively new development in the treatment of thoracic scoliosis and is purported to be effective in halting the further progression of scoliosis for patients with curves of up to 50 degrees. The Spinecor is a flexible bracing system that is made up of a series of bands that wrap around the body and a pelvic "anchoring" system that provides the tension that gradually pulls the spine and surrounding muscles into place. In contrast to hard bracing systems, patients are able to participate in physical activities and maintain normal flexibility while wearing the Spinecor.
In severe cases, where scoliosis is rapidly progressing or where the thoracic curvature is causing (or threatening to cause) damage to the heart or lungs, surgical treatment options may be considered. The goal of surgery is to stabilize the spine through the use of implanted hardware (such as rods or pins) and to halt further progression of the curves. It is preferable to wait until the patient has finished growing before performing surgery, as fusing the spine impedes further growth, although this is not always possible. Following surgery, the patient should expect a long period of recovery, during which normal activities will be limited. The long-term prognosis, however, is excellent, and after healing completely, the majority of patients will have no limitations on their ability to participate in physical activities.