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Scoliosis

What is scoliosis?

Scoliosis is a sideways curve in the spine. On an X-ray, most children’s spines look straight. The spines of children with scoliosis curve to the side, like the shape of the letters S or C.

Cobb method
Cobb method.

Usually, you can begin to see scoliosis when a child is between ages 8 and 10. As the child grows and the condition progresses, the bones of the spine (vertebrae) may rotate slightly. This may make it look like the child’s waist or shoulders are uneven.

Because her ribs are being rotated, one or both shoulder blades may stick out. Her hips may seem elevated, or she may lean to one side.

Many children have slight side-to-side curves in their spines. They usually do not need treatment. The vertebrae of children with scoliosis, however, have greater than 10 degrees of tilt.

To measure scoliosis, we use the Cobb method. The image to the right shows an example of how we take the measurement.

First, we identify the vertebrae that are tilted the most. Next, we draw a line along the ends of these bones, which allows us to measure the angle of the tilt.

There are different kinds of scoliosis:

Functional scoliosis

Functional scoliosis is a curvature due to a problem that does not involve the spine, such as having legs that are different lengths or muscle spasms caused by pain. These can cause a child to lean to the side, creating the appearance of scoliosis.

Cobb method for measuring curves.
Cobb method for measuring curves.

The curvature, however, is flexible and will go away if the problem that causes the child to lean to the side goes away.

Structural scoliosis

In structural scoliosis, the spine curvature is not flexible and does not go away with a change in position.

There is no evidence that functional scoliosis will lead to structural scoliosis.

Idiopathic structural scoliosis

Idiopathic means we do not know the definite cause of the problem. This is the case for 80% of children with structural scoliosis. We do know that children with idiopathic structural scoliosis do not have other health conditions associated with scoliosis.

Structural scoliosis associated with other conditions

In about two out of every 10 cases, children with structural scoliosis also have one of these conditions:

How do you evaluate scoliosis?

We will examine your child during a clinic visit. We will ask her to bend forward so that we can check for a bump along her back that is a sign of scoliosis. We will take X-rays of your child’s spine to help determine what type of scoliosis she may have.

We also will find out whether your child might have one of the conditions that sometimes comes along with scoliosis. Finding out what type of scoliosis your child may have is important because different types of scoliosis progress in different ways and need different treatments.

Sometimes we ask that a child have an MRI of the spinal cord to make sure that a cyst or spinal tumor is not causing the scoliosis. This is more common for younger children who have large deformities in the bones in their backs.

Who gets scoliosis?

About three out of every 100 children have a measurable curve in their spines which does not have a known cause (idiopathic scoliosis). Only one of every 100 children, however, has a curve that is severe enough to need treatment.

Equal numbers of boys and girls have the smaller curves, but girls are seven times as likely as boys to develop larger curves in their backbones.

What is your experience with scoliosis?

Our team is known nationally for treating all kinds of spinal deformities in children. We have treated thousands of children with scoliosis, ranging from teenagers with idiopathic scoliosis to children with forms of the condition that involve their nerves and muscles. Each year, our spine team evaluates 500 to 600 children with spine problems.

At Children’s Hospital, we offer our patients the support of an entire medical center. Complex spine cases usually involve bigger, more severe curves that are more difficult to correct and that affect the spinal cord and lungs.

In caring for children with these more difficult cases, we often like to enlist the services of a pediatric pulmonary specialist and a neurosurgeon.

Our surgical spinal cord monitoring team leads the country in developing new techniques for making back surgery safer. Recently we have developed advances in spinal cord monitoring and treatment of scoliosis in very young children (infantile scoliosis).

How do you treat scoliosis?

Our options include a full range of the most current treatments for children with scoliosis, including investigative treatments when they are appropriate for your child.

We perform surgeries to correct spinal deformities, and we also offer treatments that do not involve surgery.

Non-surgical treatments

Young children whose spinal curves are between 20 degrees and 40 degrees may benefit from wearing a back brace to stop the curve from getting worse as they grow.

If your child begins treatment with a brace, she may wear it until she is finished growing or until the curve gets so large that she needs surgery.

With this therapy, fitting the brace correctly is important. We have extensive experience in making braces to fit children of all sizes and ages. Read about braces and our other orthotics and prosthetics services

Interventions such as massage, physical therapy, chiropractic manipulations, exercise programs and electric stimulation do not hurt the spine, but they have not been shown to correct scoliosis or prevent the progress of it.

Surgery for scoliosis

Children with spinal curves that are greater than 50 degrees may need surgery. Our surgical team uses a number of operations to correct the curve and stabilize the spine.

Spinal instrumentation.
Spinal instrumentation.

Spinal fusion

The most common operation for scoliosis is spinal fusion, which straightens your child’s spine by releasing some of the ligaments and joints around the spinal cord and attaching a metal rod to the bones in her back.

In a spinal fusion operation, the doctor makes an incision to reach your child’s spine. He reaches the spine either from the back, which is called a posterior approach, or from the side, which is called an anterior approach.

The doctor puts hooks or screws in the vertebrae, removes the joints between the bones and attaches the rod to the hooks or screws.

He repositions your child’s spine so that it is straighter, then tightens the screws or hooks to make sure they are firmly attached to the rod. He then places a bone graft along the spine to help the vertebrae grow together.

Spinal fusion using thoracoscopy

More recently, we have begun to use a minimally invasive procedure called thoracoscopy to put in spine-straightening rods.

In this operation, the doctor uses special equipment to view the procedure on a monitor. Through small incisions in your child’s chest, he inserts tiny tools attached to the end of long rods.

These tools help him attach the metal rod to the vertebrae. With this operation, the doctor does not need to make a large incision.

We usually consider this operation only for children with moderately large curves in the chest portion of their spines. The surgery is best done by medical center staff with extensive experience in thoracoscopic work. At Children’s, we have performed more than 50 thoracoscopic procedures for spinal deformities.

Growing spine system

This procedure may help very young children whose spines are still growing and who are not helped by treatment with a back brace.

The operation is called “growing spine system” because it uses spine-supporting metal rods that can be lengthened as your child grows. As in spinal fusion, the doctor attaches the rod to your child’s vertebrae, but he does not remove the joints between the bones and does not fuse the spine.

Your child will need surgery about every six months to lengthen the rod as she grows.

In addition to more conventional types of growing systems, we are one of seven centers in the United States involved in the development of a new technology called vertical expandable prosthetic titanium rib (VEPTR).

VEPTR allows us to treat spine conditions that were previously untreatable in very young children who have fused ribs, congenital scoliosis and severe chest wall deformities.

Learn more about surgical treatments for scoliosis at the University of Washington.