Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. While scoliosis can occur in people with conditions such as cerebral palsy and muscular dystrophy, the cause of most childhood scoliosis is unknown.
Most cases of scoliosis are mild, but some curves worsen as children grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly.
Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe curves.
Signs and symptoms of scoliosis may include:
With most scoliosis cases, the spine will rotate or twist in addition to curving side to side. This causes the ribs or muscles on one side of the body to stick out farther than those on the other side
Scoliosis treatments vary, depending on the severity of the curve. Children who have very mild curves usually don't need any treatment at all, although they may need regular checkups to see if the curve is worsening as they grow.
Bracing or surgery may be needed if the spinal curve is moderate or severe. Factors to be considered include:
If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in children whose bones are still growing. Bone maturity can be checked with hand X-rays.
If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents the curve from getting worse.
The most common type of brace is made of plastic and is contoured to conform to the body. This brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.
Most braces are worn between 13 and 16 hours a day. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.
Braces are discontinued when there are no further changes in height. On average, girls complete their growth at age 14, and boys at 16, but this varies greatly by individual.
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse.
Surgical options include:
If your curve is greater than 45 to 50 degrees, it will very likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. Surgery is recommended.
Spinal fusion is very successful in stopping the curve from growing. Today, doctors are also able to straighten the curve significantly, which improves the patient's appearance.
Most fusions last from 4 to 8 hours, depending on the size of the patient's curve and how much of the spine needs to be fused. Some of this time is spent preparing the patient for anesthesia, hooking the patient up to various monitors, and positioning the patient to be as safe and comfortable as possible.
If rods are used in a fusion, they usually are not removed. Very few people require rod removal. When it is required, this may be for a variety of reasons, such as an infection or broken rod.
Several institutions are investigating fusion-less spine surgery in younger patients with moderate curves (45 to 50 degrees) who are still growing. However, more patient follow-up is needed to determine the usefulness of this tethering growth modulation surgery, and its lasting effect. At this time, the gold standard for surgical treatment of scoliosis is still fusion surgery.
Your surgeon will detail any limitations you have after surgery. Most patients will be asked to avoid heavy lifting and to minimize the amount of bending forward for the first 6 weeks.
Yes. Some patients may need physical therapy after surgery, but they are able to walk when they are discharged from the hospital.