Severe scoliosis is informally defined as a case of scoliosis that has progressed to the level where surgery is typically recommended (a 40-45 degree Cobb angle in adolescents, 50-55 degrees in adults). Curves of this magnitude have a very high risk of continuing to worsen. The main reason that surgery is recommended at this level is to halt this continued progression. If the scoliosis progresses to very high levels (a Cobb angle around 90 degrees), it can begin to cause severe problems with the lungs and heart. For this reason, cases of severe scoliosis must be taken very seriously.
Almost every case of severe scoliosis is accompanied by changes in posture and appearance. Sometimes surgery is effective in reducing or reversing these changes, but not always.
With severe scoliosis, there are some aspects that can be difficult to hear, but are nevertheless important to be aware of.
First, many cases of severe scoliosis have the potential to continue to progress throughout life. Even surgery is not always successful in preventing this continued progression. In the absence of any treatment, or if treatment is started but not maintained, the Cobb angle can increase even after the spine is done growing.
Second, if your goal is to avoid surgery, your options are limited. Most experts agree that bracing is ineffective in cases of severe scoliosis. Braces are prescribed to prevent moderate cases of scoliosis from progressing to surgical levels – not to reverse or reduce a severe case of scoliosis. CLEAR does NOT recommend traditional (non-CLEAR) chiropractic for the treatment of severe scoliosis, especially in adolescents. Adults with scoliosis may find some relief through traditional chiropractic, yoga, dynamic bracing, physical therapy, or scoliosis-specific exercises, however, be aware that the scientific evidence regarding the traditional conservative management of adult scoliosis is discouraging. Adolescents with severe scoliosis should be very careful when selecting one of the above options as an alternative to surgery, and they and their family members should research every option thoroughly.
Third, if you make the decision to undergo CLEAR treatment in an effort to avoid surgery and reduce the signs and symptoms of scoliosis, treatment will require a significant, long-term commitment. One round of treatment will most likely not be enough. Severe scoliosis must be monitored and cared for in the long-term. The extent of care that may be needed is typically reduced after the spine has finished growing, but depending upon the severity of the scoliosis, follow-up care may still be required.
The one exception concerns adults with scoliosis (excluding cases of de novo or degenerative scoliosis); if a case of adult scoliosis is stable and has not progressed in many years, the main goal of treatment might be to reduce pain and symptoms and to improve function. In this instance, one round of treatment may be enough to achieve the results that the patient is looking for. Follow-up care would then be determined according to the re-emergence of symptoms or limitations.
In addition to these points, there are other important considerations when young, skeletally-immature patients with severe scoliosis receive CLEAR treatment.
First, it is the official policy of CLEAR that every skeletally-immature patient with severe scoliosis who is undergoing CLEAR treatment must be simultaneously co-managed by an orthopedic surgeon, and patients and their parents are required to consult with an orthopedic surgeon before beginning CLEAR treatment. This is because if the scoliosis proves to be highly progressive, or if the patient is non-compliant with their CLEAR exercise program, there needs to be an orthopedic surgeon who is available and familiar with the patient’s case that is prepared to perform the surgery, should the parents/guardians decide to do so.
Second, if a patient is non-compliant with keeping their appointments and doing their home exercises, the CLEAR Certified Doctor does have the right to dismiss them as a patient and discontinue working with them. These patients will be given an appropriate referral to the co-managing orthopedic surgeon, but they will no longer be considered a candidate for CLEAR treatment. Every doctor is responsible for the patients under their care, and the effectiveness of CLEAR treatment is greatly reduced if the patient is non-compliant. For this reason, CLEAR does NOT recommend that non-compliant skeletally-immature patients with severe scoliosis continue receiving CLEAR treatment. If a non-compliant patient insists upon receiving CLEAR treatment, the CLEAR Certified Doctor will ask them to sign a form stating that they understand they have been non-compliant, that non-compliance reduces the effectiveness of the treatment, and that they are requesting to continue to receive CLEAR treatment against their CLEAR Certified Doctor’s recommendations.