What is Scoliosis?
Scoliosis is an abnormal curvature of the spine. Everyone has anatomical curves in the spine that are front-backward curves (kyphosis and lordosis), and when looked at from behind, the spine appears straight. However, children and teens with scoliosis have an abnormal S-shaped or C-shaped curve of the spine that go side to side which is most apparent when looked at from the back and bending forwards. This can cause one shoulder to be higher than another, or one hip to be higher than another.
What Causes Scoliosis?
In most people, the cause of scoliosis is unknown and it called idiopathic. This means researchers and doctors do not know the exact cause. However, we think that a combination of factors plays a role in the development of scoliosis, such as genetics, congenital factors, or hormones. Bad posture or carrying a heavy backpack or sports does not cause scoliosis. However, having good postural awareness and having a healthy lifestyle is good for overall spine health. We diagnose scoliosis by examining your child or teen and taking x-rays. This helps doctors develop a treatment plan depending on the severity of the curve. Children and teens with milder curves may just need to visit their doctor for regular check-ups. Others may require bracing or surgery.
Who Gets Scoliosis?
Anyone can get scoliosis. Idiopathic scoliosis, the most common type, usually begins developing in children age 11 and older. Girls are more likely than boys to have this type of scoliosis. You are more likely to have scoliosis if your parent, brother, or sister has it.
Does the curve progress?
Although we do not know the cause of idiopathic scoliosis we do know that curves tend to progress based on two major factors: growth remaining in the spine and the curve size. Idiopathic scoliosis curves can get larger during growth of the spine especially during the rapid adolescent growth spurt. Age, the timing of the onset of menstrual periods in girls, the status of the growth plates of the pelvis and hand are all good predictors of how much spine growth is left. Your physician can review these parameters to estimate the risk of curve progression in your child. Even after your child stops growing, a large curve can get worse. Generally, curves in the thoracic spine greater than 45 or 50 degrees and lumbar curves greater than 35 or 40 degrees will progress even into adulthood. When significant growth remains AND the curve is larger than these thresholds, curve progression is 100 percent.
How Do We Treat Scoliosis?
The goal of treating scoliosis is to stabilize the curvature of the spine, not to ·correct· the curvature. There are 3 ways we can help stabilize the curvature:
1. Observation 2. Bracing
3. Surgery
With treatment, observation, and follow-up with a spine doctor, most children and teens have normal, active lives. You may still have a curvature in your spine, but this curvature does not limit you from doing daily activities and participating in physical activities that you enjoy.
What is Observation?
Observation involves routinely following up with your provider at recommended times (every 3 months, every 6 months, every year, etc). With observation, new radiographs of your spine are obtained at each visit to monitor your curve and ensure the curve remains relatively stable. Observation is usually recommended in young children with mild curves that are notsevere enough for bracing but that are a high risk of progression. Observation is also recommended in children who are skeletally mature and whose curves have low risk of progression. While observing curvatures, it is important to maintain good overall spine health. We recommend the following:
1. Get 30 minutes of exercise daily. Walking, running, jumping, sports (soccer, football, tennis, basketball, baseball, softball), dance, gymnastics are all safe activities!
2. Include 15 minutes of pilates and yoga to your daily regimen to develop good core strength. This can also help with back pain.
3. Eat a healthy balanced diet of fruits, vegetables and protein.
4. Ask your spine doctor about formal physical therapy or Schroth PT* if having
significant musculoskeletal pain.
*Schroth PT is a special form of physical therapy that focuses on postural awareness in kids with scoliosis. There are very few certified Schroth physical therapists, and there can be long wait-lists to see them. Most do NOT accept insurance. It is not a necessary form of treatment. But if interested, please talk with your spine doctor.
What is Bracing?
Bracing is a recommended treatment option if:
1. Your curve is 25-45*.
2. You are skeletally immature and your curve has progressed >5*.
The goal of bracing is to stabilize your curve as you continue growing. Remember, the goal is not to “correct” the curvature.
What is Surgery?
The most common surgical treatment for scoliosis is spinal fusion, also known as, arthrodesis. In this procedure implants are attached to your spine to hold the spine in its new corrected place until the vertebrae are fused. Implant anchors can include polyester bands, hooks, screws and wires. These anchors are attached to rods which hold the spine in its corrected position. The anchors and rods can be made of stainless steel, titanium or cobalt chrome. Titanium and cobalt chrome implants will allow the patient to have an MRI in the future if necessary. Spine implants can be attached to the front or side of the spine (anterior spinal fusion), or the back portion of the spine (posterior spinal fusion). • In most cases, only a partial correction of the curve size can be completed. Sometimes dramatic corrections can be done, but in most patients complete correction of the curve is not possible or safe. Bone graft material is placed along the spine to help fuse the correction. There are several choices for bone graft, and these include local bone from the surgical area, bone taken from your pelvis, donor bone, and bone graft substitutes.
Vertebral Body Tethering
Vertebral body tethering (VBT) is a newer surgical option for treating scoliosis in children and adolescents who have flexible scoliosis. Unlike traditional spinal fusion surgery, which permanently fuses the curved vertebrae together, VBT works by guiding the spine to grow straighter over time while preserving motion and flexibility. The procedure involves placing screws into the vertebral bodies (the bones of the spine) on the outer, convex side of the curve and connecting them with a strong, flexible cord or cable. This cord compresses the outer side of the curve, which slows growth on that side while allowing the inner side to continue growing normally—a principle called growth modulation. As your child continues to grow, this difference in growth rates gradually straightens the spine. The surgery is typically performed using minimally invasive techniques through small incisions in the chest, and most patients go home within a few days. Not every child is a candidate for VBT, in order to determine if you child is a candidate we will need to obtain special bending X-rays as well as measure the curve size.
