PERSONAL HEALTH : POINT / COUNTERPOINT : Scoliosis Treatment: Braces vs. Stimulation

Scoliosis, an abnormal curvature of the spine, afflicts some 700,000 children ages 10 to 14, according to the Scoliosis Research Society. When the spinal curve reaches 25 degrees and seems to be progressing, most doctors recommend nonsurgical treatment. Under debate is the best approach: to wear a brace or to undergo electrical stimulation during sleep. Both approaches aim to arrest the progression of the curve and eliminate the need for surgery. Costs and length of treatment are comparable for braces and electrical stimulation. Here, two experts discuss the two approaches.

Electrical Stimulation: Dr. Susan Swank, Downey orthopedic surgeon, USC assistant clinical professor of orthopedic surgery

“Electrical stimulation (at very low levels) causes muscle contractions along one side of the spine, thus creating a force on the spine which theoretically unbends it. We try electrical stimulation first if the patient asks for it or if he or she is unable to tolerate a brace. The best candidates for electrical stimulation are teens who are still growing (and) with documented curve progression or curves more than 30 degrees. They should be mature teens who have a good parent-child relationship, who won’t use the treatment as a battleground.

“In tests, electrical stimulation has not worked as well as braces. Electrical stimulation isn’t a panacea. Some kids don’t use it every day. Some don’t dial up the stimulation to a level high enough to get muscle contractions. There are not many problems with skin reactions to the electrode pads or the gel (used with the stimulation unit).”

“Neither of these treatments--braces or stimulation--straightens the spine to normal. Nonsurgical treatment is meant to arrest curve progression.”

Brace: Dr. Edgar Dawson, professor of orthopedic surgery, chief of UCLA Spinal Deformities Service

“Electrical stimulation has seen its time. It is ineffective for most patients. I think most doctors have given up on it.

“Bracing is still a valid treatment. The brace hinders gravity’s effect on the spine, thus keeping it from bending or curving more. The majority of patients who wear a brace do so for about three years, and most don’t have to go on to surgery.

“Bracing does have two drawbacks. One is cost. Today, the cheapest brace is about $2,000 and insurance companies don’t always reimburse. The second is the dilemma for appearance-conscious teens and preteens.”