If your child has been diagnosed with scoliosis, you probably have a few questions. What is scoliosis, and will my child need surgery to correct the problem?
Scoliosis is a muscular disorder in which the spine curves abnormally to the left or right into a "C" or "S" figure. This is diagnosed by an x-ray and any curve over 10 degrees is considered scoliosis. Approximately 80% of scoliosis cases are idiopathic, meaning doctors don't know what caused the curvature.
"The most common type of scoliosis is known as adolescent idiopathic scoliosis which appears in active, healthy teens and preteens, sometimes boys, but more often girls," says Christopher Redman, M.D., a board-certified orthopedic surgeon at the Children's Health℠ Andrews Institute for Orthopaedics & Sports Medicine. "Scoliosis is more than just a bending of the spine. It is a three-dimensional deformity of the bones in the back with twisting and rotating of the spine."
Fortunately, most children with scoliosis will not need surgery to correct the condition. In fact, the majority of scoliosis does not require treatment and is simply observed during growth. When necessary, there are a few non-operative options that can be used to prevent a curvature from worsening as kids grow or, in some cases, actually improve the curvature.
How to treat scoliosis
As a first step in treating scoliosis, your physician should perform a thorough physical exam. Your child will likely require an x-ray or other imaging test to help doctors evaluate the condition of the spine, determine the extent of the curvature and map out a treatment plan.
"We focus on how to stop the progression of scoliosis. For example, if the child has a 15-20-degree curve, we try to stop it so that it does not become a 45-50-degree curve," explains Dr. Redman. "The appropriate treatment depends on the magnitude of the curve, the location of the curve in the spine and the child's developmental stage of maturity in their bones."
Nonsurgical treatments for scoliosis include observation, physical therapy, the Schroth method, bracing and Mehta casting.
If your child has only a slight curvature of the spine – less than 20 degrees – no immediate treatment is usually necessary. Depending on the curve size, your physician may check the child's spine regularly until the child has stopped growing (around late puberty) to make sure the curve is not progressing and that other health problems don't arise. If your child's curve does progress beyond 20 degrees, your doctor might recommend additional treatments to prevent worsening of the curvature as they grow.
Physical therapy for scoliosis
If your child is experiencing pain as a result of the spine's curvature, traditional physical therapy can help. Physical therapists work to strengthen your child's back and leg muscles, increase flexibility and prevent injury. The therapist may use general flexibility techniques, focus on your child's core or try manual therapy, in which the therapist's hands guide and retrain the patient's movements. Although physical therapy doesn't correct the curvature, it can alleviate your child's discomfort.
Schroth Method for scoliosis
For children with certain types of spinal curves, you might consider a specialized type of physical therapy called the Schroth method. While research is limited, Schroth method is the only form of therapy shown to improve curvature. With the Schroth method, a specially trained therapist demonstrates how to perform a series of breathing, stretching and strengthening exercises in five different positions:
- Lying on the back
- Lying on each side
- On hands and knees
Schroth exercises are customized to meet the treatment needs of each child. For example, a child might have rib prominences and flatter areas throughout the back because scoliosis has caused the spine and ribs to rotate. Schroth exercises can treat these issues by strengthening the muscles that support the child's posture and improve alignment.
The benefits of the Schroth method for scoliosis include:
- Improved mobility
- Reduced pain
- Stronger core and back
- Realignment of the spine – improved posture
- Prevention of the curve from getting worse
- Improved heart and lung function
The Schroth method is particularly effective while your child is still growing. It can also be used in conjunction with bracing or surgery. Schroth therapy requires a large time commitment and involvement from the patient and may not be suitable for all patients. Your physician will assist in determining if this is a possible treatment option.
Bracing for scoliosis
If your child's spinal curve is greater than 20 degrees, your physician might suggest a custom-made brace. This is most typically prescribed for patients with curvatures greater than 25-30 degrees with significant skeletal growth remaining. A health care professional called an orthotist makes the brace, working closely with your physician to ensure correct fit and comfort. The goal of bracing is not to correct the curvature but is used to prevent a spinal curvature from worsening as the patient grows.
To be effective, the child must typically wear the brace for a minimum of 18 hours a day. Not everyone is a good candidate for a brace – it depends on the type of scoliosis and extent of your child's spinal curve. Your physician will explain the best option for your child.
Mehta casting for scoliosis
For babies and toddlers who are diagnosed with severe curvature (called infantile or early onset scoliosis), your doctor might suggest a treatment called Mehta casting. Mehta casting involves the physician applying a cast around the child's back and chest using a special technique designed to correct the deformity of the spine over time. This is typically performed under general anesthesia and the cast is changed every 2-3 months while the child grows. This procedure may require several cast changes during treatment but potentially allows the physician to fully treat the curvature without any incisions. For some children, a brace or surgical treatment may also be needed in the future.
What degree of scoliosis requires surgery?
Fortunately, most cases of scoliosis do not require any treatment and very few require surgical treatment. If your child's spinal curve progresses to more than 40-50 degrees, depending on location, or if your child's curve is advancing rapidly, your doctor might recommend surgery.
If your child completes their growth and their curve is less than 40-50 degrees, it should not cause significant problems in life or significantly worsen. Therefore, surgery is not typically recommended. If your child's scoliosis does require surgery, many advanced surgical techniques are available that can correct the curve as much and safely as possible.
Learn more about scoliosis treatments
The highly trained pediatric spine specialists at the Children's Health Andrews Institute Spine Center use advanced treatment technology and techniques to treat all children with spinal irregularities and scoliosis. Learn more about our spine and scoliosis treatment program.
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