Scoliosis (skoe-lee-OH-sis) is a deformity of the spine which results in a rotation and curve of the spine. Instead of a straight line down the middle of the back, a spine with scoliosis curves may look more like an “S” or “C”. It may be associated with asymmetry of the neck, shoulders or waist.
An x-ray of the spine is needed to evaluate scoliosis. The curve of the spine is measured as an angle in degrees called a Cobb angle.
Most scoliosis curves are small and never cause any problems. There is usually not any discomfort or change in function of the spine. The spinal asymmetry associated with scoliosis may be noticed by parents in summer when they see their child in a bathing suit, found on a routine physical or school screening or incidentally on an x-ray done for other reasons. Scoliosis is confirmed with an x-ray of the spine. The type of treatment required depends on the degree of the curve, the child’s age, and the time and amount of growth remaining until the child reaches skeletal maturity.
There are several different types of scoliosis that affect children. The three main types of scoliosis in children include idiopathic, congenital and neuromuscular/syndrome-related scoliosis.
The most common type of scoliosis is “idiopathic”, which means the exact cause is not known. Approximately 80% of patients with scoliosis have this type.
Idiopathic Scoliosis can occur at any age.
Congenital scoliosis is a curvature of the spine that occurs during fetal development. The curve occurs as a result of abnormally shaped bones in the spine and/or ribs
Neuromuscular/Syndrome-related Scoliosis is a curving of the spine related to a defect in the nervous or muscular system. This type of scoliosis is associated with a number of syndromes including but not limited to cerebral palsy, spina bifida, muscular dystrophy, spinal cord tumors, neurofibromatosis, paralytic conditions or traumatic spinal cord injuries.
Idiopathic scoliosis (the most common type) can be present with little or no outward signs. Children usually are not limited in their activities. Idiopathic scoliosis does not usually cause back pain, leg pain, neurological dysfunction, or respiratory problems. The first sign is usually a subtle difference in appearance of the back that is noticed by a parent, doctor or school nurse.
Physical signs of scoliosis include:
The specific treatment required for your child’s scoliosis will be determined by the physician based on:
Tools that help estimate your child’s remaining spine growth may include x-rays of the pelvis and/or hands.
If the curve is mild and/or the child is near skeletal maturation this may be appropriate
The goal of bracing is to limit the curve from getting worse. A special back brace called a thoracolumbar spinal orthosis (TLSO) may be prescribed. Bracing is recommended when there is significant risk for the curve to worsen.
One surgical procedure is called a “Spinal fusion”. This surgery involves stabilizing the scoliotic portion of the spine with hardware that may include rods, hooks and/or screws. The goal of surgery is to obtain fusion of the bone to prevent further progression of the curve. An added benefit is often cosmetic improvement.
This surgery may be recommended if:
In general, after scoliosis surgery it is possible to return to most sporting activities within 6 months to one year.
If left untreated, curves greater than 50° are at increased risk for worsening and can potentially lead to long term health problems involving the heart and/or lungs. Additionally, the cosmetic aspects of scoliosis become concerning to many patients and families
Other surgical procedures for younger children may consist of implanting ‘growing rods’. The term ‘growing rod’ loosely means instrumentation without fusion. This procedure is used in young patients with rapidly progressive curves despite aggressive brace therapy. A limited fusion is performed at the top and bottom of the affected spine with hooks to hold a more subcutaneous rod in place. Subsequent distraction (minor surgical procedure to lengthen the rod) is performed every six to 12 months during the child’s growth phase. Eventually, these children will have a spinal fusion and may be braced in addition during growth.
A Vertical Expandable Prosthetic Titanium Rib is a Synthes™ device indicated for treatment of thoracic insufficiency syndrome (TIS) in skeletally immature patients. This is defined as the inability of the thorax to support normal organ growth. Young patients with scoliosis with or without rib abnormalities or congenitally malformed vertebrae fall into this category. Again, this is only a temporary measure that enables the thoracic cavity and spine to grow until a spinal fusion can be performed. Nationwide Children’s Hospital is the first hospital in Ohio to receive access to the VEPTR device. Less than 10 surgeons in Ohio have accessibility to the VEPTR device and need to be approved by the Institutional Review Board.
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At Nationwide Children’s, every child diagnosed with a an orthopedic problem is handled with an individualized treatment plan.
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