Scoliosis in Children and Teens

What is it? 

Scoliosis is an abnormal curve in the spine that often appears as a child is experiencing a growth spurt. All spines have some curves that are normal. Scoliosis is when the spine curves to the side (lateral curvature) and sometimes has an “S” shape.

The scoliosis curve may increase depending upon the degree of the curve when diagnosed and the amount of growth the child has left to do. Younger patients that have curves are likely to have large increases in their curve, especially during growth spurts. 

There are three general categories of idiopathic scoliosis (meaning the cause is unknown):

• Infantile Idiopathic Scoliosis: ages 3 months to 3 years
• Juvenile Idiopathic Scoliosis: ages 4 to 9
• Adolescent Idiopathic Scoliosis: ages 10 to 18

Other types of scoliosis are:

• Neuromuscular Scoliosis - scoliosis that is associated with another diagnosis, such as cerebral palsy, spina bifida or muscular dystrophy
• Congenital Scoliosis - meaning a child’s vertebrae in the spine are abnormally shaped at the time of a their birth

Why come to Children's Hospital Colorado for treatment of this scoliosis?

The pediatric orthopedic specialists at Children's Hospital Colorado have experience in treating the full range of scoliosis that can occur in children and teens. We care for infants to young adults with varying degrees of this condition and follow them throughout their growing cycles to ensure they are receiving the best treatment as their bodies are growing and changing.

Children's Hospital Colorado Spine Program has a dedicated team of professionals who specialize in caring for all types of pediatric spinal deformities. The goal of our team is always to provide the most conservative, yet most effective treatment as possible.

Our surgeons perform 160 to 175 spine procedures a year on pediatric patients. If a patient requires surgery, we provide a coordinated and informative preoperative preparation process. All of our spine surgery patients receive a resource guide and extensive preoperative teaching which will help make the surgical process easier on the patient and their family.  

What are the signs and symptoms?

Scoliosis typically appears while a child is going through a growth spurt. This condition may cause some of the following symptoms.

• One shoulder is higher than the other
• Uneven rib cage or “rib hump”
• Waistline is uneven or one hip seems higher than the other
• Back may appear crooked
• Some patients experience back pain, but many do not

How do you diagnose it?

Scoliosis is usually identified during a child’s routine physical exam. If your child’s doctor detects a curve in their spine, they may order an x-ray to determine the degree of the curve, or they may refer you to a pediatric orthopedic specialist.

How do we treat it?

Generally, treatment will involve observation, bracing or surgery. Your child’s pediatric orthopedic specialist will help you and your family determine which treatment is best for your child. Because scoliosis changes as a child grows, it is important to monitor its progression closely and have x-rays two or three times per year during the growth cycle.

Physical therapy, stretching and core fitness exercises, such as Pilates, are also encouraged for patients with scoliosis, however research has shown that these will not prevent or cure scoliosis.

How scoliosis is treated depends on many variables including:

• Type of scoliosis (see below for treatment options specific to scoliosis type)
• The child’s age
• The degree of the scoliosis
• Other associated medical conditions

Infantile Idiopathic Scoliosis

This type of scoliosis generally requires observation and/or casting. If a cast is chosen for treatment, the cast used is called a Risser cast or body cast. It is custom molded and works by providing a gentle push on the patient’s curve. The cast is changed approximately every eight weeks. The patient will need to be put to sleep under general anesthesia for the procedure, as it is necessary for them to be completely still for the cast application. The goal of casting is to straighten the spine, however casting is still considered successful if it slows the progression of the curve.

Juvenile/Adolescent Idiopathic Scoliosis

This type of scoliosis can call for observation, bracing or surgery. Smaller curves generally only need to be monitored and the child should be seen every 4 to 6 months for an examination and an x-ray. Curves that are progressing may benefit from bracing.

If bracing is an option for a child with this type of scoliosis, the brace most often used is called a TLSO (thoraco-lumbar-sacral orthosis), which is worn under clothing and is custom-molded to provide pressure against the curve in the spine. Current research has not determined if bracing is effective in treating scoliosis. The main goal of bracing is to keep the curve from becoming worse – it does not cure scoliosis.

More severe curves may require surgery. The goal of surgery is to decrease the size of the curve and to stop progression of the curve. After surgery, most patients will typically spend 4 or 5 days in the hospital and can return to full activities after 4 to 6 months. Most patients return to school 3 to 4 weeks after surgery.

Neuromuscular Scoliosis

This type of scoliosis calls for observation, bracing or surgery. Management of scoliosis in patients with other underlying diagnoses, such as cerebral palsy and muscular dystrophy, can be more challenging. Bracing and wheelchair modifications may help manage the scoliosis as the patient grows, but will not cure it. If the patient requires surgery, an extensive preoperative evaluation may be done to evaluate the current medical condition of the patient and prepare the family for the upcoming surgery and for discharge from the hospital. Patients with neuromuscular scoliosis who have surgery may be in the hospital anywhere from 7 to14 days and return to school in approximately 6 to 8 weeks after surgery.

Congenital Scoliosis

This requires observation and/or surgery. Patients with congenital scoliosis need to be observed closely as the curve may progress rapidly as the child grows. The doctor will determine treatment based on the child’s age and the size of the curve.

Who gets it, and can it be prevented?

Idiopathic scoliosis, meaning the cause is unknown, can appear in otherwise healthy children or adolescents. It occurs in approximately 2.5 out of 100 children. Of those children who do develop scoliosis, only a small number will actually need surgical treatment. Infantile idiopathic scoliosis is more common in boys. Juvenile and adolescent idiopathic scoliosis is 4 to 5 times more common in girls. There are currently not any known preventative measures that can be taken against scoliosis.