Skeletal specimen of adult female showing<unk>  (curvature of the spine), 1830–1860. Photographer: Kikel, V. R. The decision to choose a particular treatment approach very much depends on multiple factors such as the age of the patient, understanding the root cause of the condition i.e. postural, congenital, etc., risks involved in surgery for the patient, etc. * Physical therapy: When the extent of curvature is mild, and the underlying cause is bad posture, and then physical therapy becomes the first line of treatment. Physical therapy may also be advised for other causes as well to delay the development of abnormal curvatures, such as in the case of elderly patients suffering from the degenerative disease of bones and cartilage. The primary objective of physical therapy is to strengthen the spinal tissues for either correcting the curvature to the maximum extent possible or contain further damage. * Back braces: In the cases when the underlying reason for deformity is postural and is detected before the growing age of bones, braces can be used. Braces provide support to the muscles and bones, as well as apply corrective pressure to reduce the curvature. The braces for<unk>  have to be designed such that it becomes effective with both abnormal curvatures in the coronal and sagittal plan. The latest in brace design is through the use of CAD/CAM, which is available only in few developed countries such as Germany. The efficacy of braces for correcting curvature issues has been analyzed by a few studies. In one such study, it was found that bracing led to successful outcomes in 72% of patients and correlated strongly with hours of braces worn. However, compliance with wearing braces for a period up to 18 hours or more can be physiologically and psychologically limiting, especially when one considers the teenage period. * Surgery: see below. * Oxygen on long term may be necessary in patients with significant hypoxemia. Surgery Surgery is usually indicated when the extent of deformity is large, causes issues in physiological functions such as breathing, interferes with the daily activities or is cosmetically unacceptable to the adult. It is also advised when the patient has passed the age where other therapies such as braces are no longer effective.<unk>  implies that the patient has both types of curvature deformity. The decision to undergo surgery or not is always a complex one, but sometimes, it becomes inevitable such as when the deformity begins to interface with crucial physiological functions like breathing or makes every day normal activities extremely painful. Sometimes, patients in their early adulthood may choose to have surgery because the presence of such deformity causes social issues such as acceptability among their peers, a disability that comes in the way of working, etc. In the case of elderly patients who suffer from such deformity triggered at a later age, other factors are to be considered such as the presence of underlying disease that caused it, whether a progressive decline is expected, and if conservative treatments using physiotherapy or drugs have failed to give relief from debilitating pain. Surgical correction is attempted in some to fix the spine and arrest progression of the deformity. Surgical operations may include the use of spinal implants like the Harrington Rod, or the VEPTR. Risks of corrective spine surgery: studies Another study which focused on elderly patients found that the rate of complications was much higher for a sample population of 72 cases with mean age of 60.7 years. The rate of complications was as high as 22% in the entire sample. The study points that in the case of elderly patients, surgery should only be considered when there is no other option left; the disease is in progression stage, and the quality of life has degraded to an extent where conservative treatments can no longer help with pain. While there are many surgical approaches for spinal deformity correction including anterior only, posterior only, anterior-posterior, the techniques that are most popular nowadays include the posterior only VCR or pVCR. One of the studies which analyze pVCR technique also noted the benefit of using a technique called NMEP monitoring in assisting the surgeon avoid any neurological complications while performing a spine surgery.
Kyphoscoliosis
Poliosis
Scoliosis
Metaphyseal dysplasia
Otospondylomegaepiphyseal dysplasia
Multiple epiphyseal dysplasia
Hip dysplasia
Swan neck deformity