Children's Hospital Colorado

Adolescent Idiopathic Scoliosis (Ages 10-18)

What is idiopathic scoliosis?

Scoliosis is a curvature of the spine that measures greater than 10 degrees on an X-ray. It's often first noticed during growth spurts in adolescence.

Scoliosis can be caused by a variety of things including:

  • Genetic syndromes such as osteochondrodystrophy (dwarfism) or neurofibromatosis
  • Neurologic or muscle disorders such as cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy or spina bifida

Most often, no cause is identified. In these cases, we use the term idiopathic scoliosis. There are two general categories of idiopathic scoliosis:

Vea este video en nuestro canal de YouTube para obtener más información sobre la escoliosis y cómo tratamos a los niños que padecen de esta afección de la columna.

Who gets idiopathic scoliosis?

Adolescent idiopathic scoliosis occurs in approximately one to three out of 100 adolescents. Most adolescents with scoliosis have small curves that don't require any treatment. Scoliosis affects boys and girls equally. However, girls are seven to 10 times more likely to have larger curves that require treatment than boys for reasons that are not known. There is currently no way to prevent idiopathic scoliosis.

The Connection Journey
Growing through spine surgery

Jessica and her parents share their spine surgery experience with Emily and her dad as they prepare for her upcoming scoliosis surgery. They help answer questions, shed light and offer hope – from diagnosis to surgery to recovery.

Watch their stories

What are symptoms of idiopathic scoliosis?

Scoliosis is not a painful condition for most patients. However, there are other signs that a child has idiopathic scoliosis, including:

  • Back pain
  • Imbalance of shoulders
  • Uneven waist appearance
  • Prominence of shoulder blades

How do doctors test for idiopathic scoliosis?

A physician can determine if a patient has scoliosis by performing a physical examination of the back. The physician will look for any rib prominence in the patient's back or lack of symmetry in the spine by having the patient do a "forward bend test." Following this simple examination, the physician will usually review X-rays of the spine, viewed from the back and the side, to be able to view the entire spine.

Why should you bring your child to Children's Hospital Colorado for scoliosis testing?

Children's Colorado is the only pediatric Spine Program in our multistate region with the EOS X-ray system for scoliosis. There are many benefits to using this imaging, including:

  • Reduced radiation exposure: EOS reduces a child's radiation exposure up to nine times compared with regular X-rays and it's reduced up to 40 times compared with imaging that uses micro-dose filter.
  • Better imaging: By using EOS, our doctors can create 3D models of a child's spine.

How is idiopathic scoliosis treated?

Doctors will review a few different variables to determine how we should treat a child with idiopathic scoliosis. These variables include: age of the child, severity of their scoliosis and any other associated medical conditions.

Depending on the size of the curve and age of the child, treatments can include:

  • Monitoring in the clinic with examination and low-dose EOS imaging
  • Wearing a brace
  • Completing scoliosis-specific exercises
  • In some cases, surgery

Many patients who are diagnosed with idiopathic scoliosis will only need monitoring of the curvature of their spine periodically with an examination and X-rays one to two times per year. Our pediatrics specialists may recommend bracing and scoliosis for some patients, and in severe cases, they may recommend surgery.

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

The Spine Program at Children's 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. More kids with idiopathic scoliosis get treated at our Spine Program than anywhere else in Colorado.

Our spine team is among the most knowledgeable pediatric spine care teams in the country. We are involved in cutting edge research and innovation in spine care for children and adolescents.

Our team has published over 100 articles in all the leading orthopedic and spine surgery journals and routinely speaks at international conferences and courses for other surgeons. The Spine Program has received research grants from the National Institutes of Health, Scoliosis Research Society and Pediatric Orthopedic Society of North America. Learn how we're advancing scoliosis treatment through our orthopedics research.

From 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. Learn why we have some of the best spine surgery outcomes in the country.

Who should do scoliosis exercises?

Patients with larger curves (20 to 40 degrees) and substantial growth remaining may be candidates for brace treatment and scoliosis specific exercises. These treatments can reduce the risk of the curve increasing. Scoliosis specific exercises are also very helpful for children who are having discomfort from their spinal curvature. In some cases, they may also help prevent progression of curvature.

FAQs about scoliosis specific exercises

What are scoliosis specific exercises (SSEs)?

Standard features of our SSE program include 3D self-correction, training activities with activities of daily living (ADLs) and stabilization of a corrected posture. This approach was accepted by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in 2011.

Our physical therapist Michelle Kohl explains how spine exercises can help some patient improve their spine curvature.

What are the goals of SSE?

The goals of physical therapy (PT) and SSE are:

  • Improve flexibility and strength in key muscle groups
  • Increase posture awareness by understanding (at an age appropriate level) the mechanics of the spine and the individual curve type
  • Perform the exercises in the best possible spinal alignment
  • Improve comfort of brace wear (thereby improving brace wearing compliance)
  • Address any muscular back pain that may be present in select patients with AIS

Where is it offered?

We offer SSE at our following locations:

What does the SSE program look like?

We see patients for an initial evaluation and four to five follow-up visits for instruction on the foundational exercises. Visits are typically one hour. Once the initial home exercise program is well established, patients return to PT after their periodic orthopedic physician visits so the exercises can be progressed or modified based on any changes in the curve pattern.

Who is appropriate for SSE and how are they referred for SSE?

The orthopedic physicians, physician assistants, spine team nurses and orthotist screen patients with adolescent idiopathic scoliosis (AIS) for appropriateness for referral to PT. Criteria include the following:

  • Diagnosis of AIS (without neuromuscular or other causes of scoliosis)
  • Spine curvature between 10 to 50 degrees
  • Willingness and ability to participate in a home exercise program 20 to 30 minutes, five days a week

Can patients who have had posterior spinal fusion surgery do SSE?

Outpatient PT is not routinely prescribed after spine fusion surgery. However, some factors are considered on a case-by-case basis in a discussion between the patient, parents and the orthopedic physician team. These may include:

  • If the patient has specific goals related to core strength in neutral spine
  • Learning proper lumbopelvic alignment (particularly if the patient underwent a selective thoracic fusion and lumbar spine is not fused)
  • Shoulder girdle alignment, pain or to work on mechanics for return to sport

Bracing for idiopathic scoliosis

The goal of bracing is to stop your scoliosis curve from getting bigger as you grow. 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

Our specialists most often recommend a thoraco-lumbar-sacral orthosis (TLSO) brace for patients with scoliosis. In selected cases of primary curves in the lumbar spine (lower spine), we may also consider using a nighttime-only brace.

FAQs about bracing for idiopathic scoliosis

Why do I need to wear a brace?

Bracing can reduce the risk of your scoliosis curve increasing. A 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 certain periods of time, you will have the following levels of benefit:

  • Less than 12 hours a day = no benefit
  • 12 to 16 hours a day = potential to stop the curve from getting bigger
  • 16 to 23 hours a day = maximum benefit

Your orthotist (the professional who makes the brace) will apply a monitor in your brace. It has a small thermal (heat) sensors that record the internal temperature of the brace. The sensors provide valuable information that will help you and your doctor see your actual wear time along with patterns of wearing the brace. They do not track where you go or what you do; they only measure temperature in the brace which corresponds to wearing or not wearing the brace.

When can I stop wearing the brace?

You'll wear your brace until most of your growth is done, or if your curve keeps increasing despite appropriate use. Your doctor will discuss expected length of bracing with you.

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 the overall health benefit they provide 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. Watch our core exercise videos to learn 12 exercises for strengthening your back.

It's ok to take your brace off during:

  • Exercise
  • Sports
  • Dance
  • Showering and bathing
  • Physical education 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. There may be times when friends or people around you notice the brace, like when you change for PE class, for example. If they do 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.

When is surgery recommended for adolescent idiopathic scoliosis?

Scoliosis is often recommended to adolescents with idiopathic scoliosis that exceeds 40 to 45 degrees. Scoliosis surgery can reduce the curvature significantly, while also improving:

  • Shoulder imbalance
  • Shoulder blade prominence
  • Rib hump
  • Waist balance

What happens if a patient with scoliosis doesn't have surgery for a large curvature?

Progressive scoliosis in adults has been shown to lead to increased rates of back pain and unhappiness with appearance. As the curve increases past 70 degrees, patients will often have mild restriction in their lung function, but not usually enough to require treatment.

For those who have very severe progression of scoliosis (exceeding 90 to 100 degrees), there can be severe compromise of lung function that increases the risk of:

  • Pneumonia
  • Need for supplemental oxygen
  • Restrictions on activities due to shortness of breath

What to expect from scoliosis surgery

The goal of surgical treatment is to prevent the curve from getting any more severe and to make the spine curve as straight as safely possible, generally by placing screws and rods into the spine to assist with correcting the curve. The rods hold the spine in the corrected position and allow the bone to fuse.

We plan surgeries based on the most current research and use the most advanced technology. The type of surgery we perform is based on the child's age, as well as type and severity of scoliosis and any underlying medical conditions.

How long is scoliosis surgery?

The length of scoliosis surgery varies by patient, but most are 2.5 to 3.5 hours of surgical time. Total time is typically five to six hours including anesthesia, setup, positioning and wakeup.

Our surgical approach includes:

  • Pediatric experts including orthopedic surgeons, anesthesiologists, physical therapists, social workers, nutritionists, respiratory therapists and child life specialists
  • Highly specialized nursing staff with pediatric orthopedic training
  • A welcome program coordinator who introduces your family to Children's Colorado and provides supportive services
  • Operating rooms and equipment designed just for kids, teens and young adults
  • State-of-the-art spinal cord monitoring
  • Blood conservation techniques
  • Multidisciplinary infection prevention practices
  • Several modes of pain management and control

Learn more about spine surgery and spine class at Children's Colorado.

Mire este video para aprender más información acerca de la cirugía para la escoliosis.