Treatment Options

The spine is a living structure and can undergo changes throughout the lifespan. We recommend close observation for all spinal conditions, which allows us to detect any potential changes quickly and initiate appropriate treatment as soon as possible, giving you the best long-term results!

For adolescents with scoliosis measuring less than 15 degrees, we typically recommend close observation with scoliometer checks and/or repeat low-dose x-rays every 6 months. Conservative therapies may be initiated for curves above 15 degrees, with repeat x-rays every 3-6 months. Once growing has finished, follow-up visits are recommended every year until age 25. It is important to continue following the curve throughout adulthood, with x-rays every 2-3 years.

Kyphosis must also be monitored closely both during growth and after. In older adults, degeneration and decreased bone quality can cause progression of scoliosis and kyphosis. Having more data over time enables us to track the progression and helps guide our choice of treatment options.

Check out our Video Blog about brace break-in by our Orthotist! Click here

As part of our new clinic, we have added a brace fabrication lab! Our orthotist uses 3D body scanning technology to create custom, light-weight Rigo-Cheneau style braces in-house.

What is a 3D CAD CAM Style Brace?

The 3D CAD CAM brace is a light-weight brace that addresses not only the Cobb angle of a curve, but also the rotation of the spine, providing for better corrections than other styles of braces. Studies have shown that this particular brace can halt curve progression, help with pain and sometimes even improve curve measurements.

How does it work?

The brace applies pressure to certain areas of the spine, while also having expansion areas to allow for de-rotating and straightening of the spine. It is customized to fit a person’s body shape and size based on a 3D scan. The orthotist then makes additional modifications to improve fit and comfort, as well as to maximize effectiveness.

What are the benefits of a 3D CAD CAM Style Brace over a Boston Brace?

It is customized to fit a person’s body shape and size based on a 3D scan and design. It provides a lot more comfort. The Cheneau Style Brace is made with a light-weight material, which allows for a slimmer design that is more comfortable and breathable than the Boston Brace. The slim design also makes it easier to hide under clothing. The Boston Brace targets only the Cobb angle of a curve, whereas the Cheneau addresses the Cobb angle and rotation of the spine, thereby providing better results. Another benefit is that the straps are located in the front of the brace, rather than in the back. This improves ease of use and allows patients to take the brace on and off independently, which is especially important for gym class, sports, and other times a parent may not be available to assist.

What is Schroth Physical Therapy?

Schroth physical therapy is a technique designed to strengthen and retrain the muscles of the back and core to hold the spine in better alignment. The goal is to elongate, de-rotate and stabilize the spine. The Schroth method consists of stretches, strengthening exercises, breathing techniques and postural training exercises using yoga blocks and balls, Schroth bars, poles and other equipment. The exercises are individualized for each person’s unique curve.

What makes Schroth different?

Schroth is a conservative, non-surgical approach to treating scoliosis. This form of treatment can be combined with bracing and has been shown to prevent progression of scoliosis and, in some cases, decrease the angle of the spinal curvature.

Schroth at the Hey Clinic

As part of our commitment to the conservative and lifelong care of our patients, we have multiple full-time Schroth certified physical therapists. The physical therapists develop a home therapy program so that the exercises can be continued on a daily basis, emphasizing our desire for lifelong care.

Some spinal conditions can be treated with an injection. There are two main types of injections that we routinely prescribe.

Epidural Steroid Injections (ESI)

A steroid, which is a strong anti-inflammatory agent, is injected into the epidural space. This reduces inflammation caused by conditions such as a disc herniation or stenosis, thereby reducing pain.

Radiofrequency Ablation (RFA)

A small electrical current is used to heat the nerves in the facet joint. This limits the nerves’ ability to transmit pain signals.

If, during your visit here, you and the clinician decide that a spinal injection is the best route for treatment, we will order the injection and arrange for you to have this done at another medical office, as we do not perform them at the Hey Clinic.

In some cases, conservative treatment may be ineffective or not a suitable treatment option if spinal curvature has continued to progress or if the patient still has significant pain. Dr. Hey may consider a surgical approach, when necessary. To date, he has performed over 6,000 spinal surgeries that he carefully plans out with his team. He operates at Duke Raleigh Hospital and Wake Med Children’s Hospital, for patients under 14 years of age.

Here at the Hey Clinic, we created our own Electronic Medical Records software so that we can better serve you. Before surgery, we use the patient records to review medical history, medications, and symptoms to create a custom pre-surgery checklist. Every week we have a team “quality huddle” to review the checklist and make final preparations, helping the surgery go as smoothly as possible. We also developed an intra-operative checklist software named 3Greens™ that we use to make aviation-style safety checklists to ensure process standardization and encourage OR team coordination. In addition, we utilize a post-op checklist to monitor our patients’ recovery both during and after their inpatient stay.

While massage, chiropractic care, Pilates, yoga, stretching and other therapies may provide symptomatic relief, these have been proven inefficient in correcting a scoliosis curve. The Scoliosis Research Society (www.srs.org) has published a paper on alternative treatments. Find more information about treatment options on their website.