Children's Hospital Colorado

Scoliosis

What is scoliosis?

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, but scoliosis is when the spine curves to the side (a 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 who have curves are likely to have large increases in their curve, especially during growth spurts.

More kids with idiopathic scoliosis get treated at Children's Colorado's Orthopedics Institute than anywhere else in Colorado. Learn why and read about our outcomes.

 

 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 his or her birth

Who gets scoliosis?

Idiopathic scoliosis (the cause is unknown) can appear in otherwise healthy children or adolescents. It occurs in approximately 2.5 out of 100 children. Infantile idiopathic scoliosis is more common in boys. Juvenile and adolescent idiopathic scoliosis is four to five times more common in girls.

There are currently no known measures that can be taken to prevent scoliosis. Of those children who do develop scoliosis, only a small number will actually need surgical treatment.

Scoliosis resources:

What are the signs and symptoms of scoliosis?

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 is scoliosis diagnosed?

Scoliosis is usually identified during a child’s routine physical exam. If your child’s primary care doctor detects a curve in his or her spine, they may order an x-ray to determine the degree of the curve, or refer you to a pediatric orthopedic specialist at the Spine Program at Children’s Hospital Colorado.

Learn more about an x-ray exam for scoliosis.

How is scoliosis treated?

Generally, treatment of scoliosis at Children’s Hospital Colorado will include observation, bracing or surgery. Your child’s pediatric orthopedic specialist at the Spine Program 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 your child’s 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

What is scoliosis surgery?

Treating infantile idiopathic scoliosis

This type of scoliosis generally requires observation and/or casting. If it is decided that casting is the best option, a custom-molded cast will be used to provide a gentle push on the patient’s spinal curve. The goal of casting is to straighten the spine; however, casting is still considered successful if it slows the progression of the curve.

Treating 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 four to six months for an examination and an x-ray. Curves that are progressing may benefit from bracing, intended to keep the curve from becoming worse.

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.

Treating 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.

Treating congenital scoliosis

Children born with this type of scoliosis need observation and/or surgery. Patients with congenital scoliosis need to be observed closely, as the curve may progress rapidly as the child grows. Your child’s doctor will determine treatment based on your child’s age and the size of the curve.

What to expect after scoliosis surgery

Why choose our Spine Program for the treatment of your child’s scoliosis?

The Spine Program at Children’s Hospital Colorado evaluates and treats infants, children, adolescents and young adults with all types of spinal diseases, deformities and injuries, ranging from scoliosis to complex neuromuscular disease and trauma. Our spine team is among the most knowledgeable pediatric spine care teams in the country.

For the most basic to the most complex spinal conditions, our goal is to always provide the safest and most effective treatments, often beginning with non-surgical options. However, if surgery is the only option, we offer innovative approaches from experienced surgeons who perform more than 200 pediatric spine procedures each year. Learn why we have some of the best spine surgery outcomes in Colorado.

Additional resources

About bracing for scoliosis treatment

Bracing is a non-operative scoliosis treatment for children who:

  • Have been diagnosed with idiopathic scoliosis
  • Are still growing
  • Have spinal curves between 20 and 40 degrees

The type of brace we use at Children’s Hospital Colorado is called a thoraco-lumbar-sacral orthosis (TLSO) brace. The goal of bracing is to stop your scoliosis curve from getting bigger as you grow.

Why do I need to wear a brace?

Bracing can reduce the risk of your scoliosis curve increasing. A high quality study published in the New England Journal of Medicine showed that wearing a brace properly reduces the risk of curve progression by about 50%. 

There is no guarantee that bracing will stop the curve completely; however, in most cases it is beneficial. We understand that not knowing if bracing will work is challenging for you and your family. What we do know is that following your doctor’s treatment plan is the key to effective bracing and outcomes.

How many hours a day do I have to wear my brace?

Research shows that the more you wear the brace, the more effective it will be at preventing progression of your scoliosis.

Data has shown that If you wear the brace for:

  • Less than 12 hours a day = No benefit
  • 12 hours a day = Potential to stop the curve from getting bigger
  • Only at night = Less benefit than wearing during the day
  • 18 to 23 hours a day = Optimal amount of time for maximum benefit

Your orthotist (the professional that makes the brace) may be able to apply a monitor in your brace. They are small thermal (heat) sensors that record the internal temperature of the brace, and provide valuable information that will help you and your doctor see your actual wear time along with patterns of wearing the brace.

When can I stop wearing the brace?

You’ll wear it until most of your growth is done or if your curve keeps increasing despite appropriate use.

What if the brace is uncomfortable?

It may take some time to get used to it. Things like bending down and even sitting on the floor will feel different at first. Don’t worry; you will adjust to these changes. 

Your orthotist will provide you with instructions on weaning gradually into the brace. You will need to contact the orthotist if you notice any areas of concern, such as redness or tightening in an area. Adjustments may need to be made to the brace in between check-ups with your provider.

Can I still participate in activities and sports?

Yes. It’s important to continue to participate in sports and exercise activities for their overall health benefit and for your general well-being. This time out of the brace allows the muscles in your core to be strengthened. Core muscles are the muscles that surround your back, abdomen, pelvis and hips. The core is the body’s center of strength.. 

Having good core strength decreases the workload and stress on your lower back. Your exercise program should involve stretching and strengthening of these muscles.

It’s ok to take your brace off during:

  • Exercise
  • Sports
  • Other active activities
  • Showering
  • PE or gym class
  • Special occasions determined by you and your family

Will everybody know that I’m wearing a brace?

Braces have low profiles and accommodate active lifestyles; they aren’t as noticeable as you might think. If your friends or people around you (for example, if you have to change for P.E. class) notice your brace, just remember that they are curious and a brace is nothing to be embarrassed about.

If you wear a loose fitting shirt, it’s often hard to see. We recommend wearing a shirt under the brace that wicks moisture away. Use a shirt made from a high performance material usually found at sporting goods stores, or even a tight fitting cotton t-shirt to absorb moisture. The shirt should be seamless to prevent wrinkling and discomfort.

Helpful resources

We have a Spine Brace Support Group that is a peer-led group for teens and tweens from 10 to 16-years-old. The group is for parents and patients’ and discusses challenges, successes and real-life experiences to help support each other. For more information call the group leader at 303-902-5593. 

Magnetic Controlled Growth Rod (MCGR) Treatment for Early Onset Scoliosis

Specialists in the Spine Program at Children’s Colorado now offer a new way to treat kids who are affected by early onset scoliosis. This new technology is a rod that specialists lengthen as your child grows – without the emotional or physical discomfort of traditional rod expansion surgeries. This means just one surgery, less pain medication and fewer missed school days as your child grows.

What to expect when the Magnetic Controlled Growth Rod is placed

Before surgery, you meet your child’s surgeon and one of our spine nurses so that they can explain more about your stay at Children’s Colorado. This pre-surgery visit includes a tour, discussion about what it is like to be in the hospital, recovery and the goals for discharge from the hospital.

Surgeons place the MCGR during an inpatient surgery at Children’s Colorado. A pediatric anesthesiologist helps kids fall and stay asleep during the surgery. Kids stay in the hospital a few days before they go home.

What to expect at your first rod expansion visit

Magnetic-Rod-Expansion-Scoliosis-Treatment.jpgAfter the initial surgery when rods are inserted into your child’s back, patients and families return to the Children’s Colorado’s outpatient clinic between two and six months later for the first rod expansion.

At the visit, your child gets into a comfortable position either on their tummy or side. Then, a pediatric spine specialist uses an external remote control to lengthen the rods from the outside of the skin. The external remote control causes the magnets in the rods to make the rods longer. Your doctor will decide how much to expand the rods on an individual basis. 

Watch a video about 10-year-old Ryan Viano, our first patient to benefit from these new magnetically-controlled rods.

The expansion is a quick outpatient visit

Rod expansion only takes a few minutes. Kids usually watch TV or play a game on a tablet during the expansion. As the rods are expanded, your child may experience a tingling or odd feeling in their back, but most don’t describe the feeling of pain during the expansion.

After we expand your child’s rods, your doctor uses imaging to evaluate the length of the rod expansion. Then, you and your child can head home and return to normal life.

Benefits of the Magnetic Controlled Growth Rod

  • Only one surgery is needed to place the rods
  • Rod expansion is done at an outpatient visit 
  • The expansion only takes a few minutes
  • No pain medication, recovery or missing school/work after the expansion

Conditions treated with the MCGR

Additional information


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