Scoliosis is a sideways curvature of the spine which is associated with rotation of the vertebrae.

The size of the curve is measured in degrees. To make the diagnosis of scoliosis, the curve must measure at least 10 degrees. Although it occurs in about 2-3 percent of the population, it is important to note that only about 5 percent of people who have scoliosis need any kind of treatment. This means that most people have a mild case.

There are different types of scoliosis.

The most common is idiopathic scoliosis, the type with which most people are familiar. However, there are other types such as congenital, neuromuscular, syndromic, and early onset.

This blog will focus on idiopathic scoliosis.

The cause of idiopathic scoliosis is not really known. Various theories have been put forth, but none are definite. Genetic studies have found sites on different chromosomes that seem to be associated with scoliosis. Though idiopathic scoliosis is familiar, it is not passed down through families in typical genetic patterns.

The incidence in boys and girls is the same with small curves, but girls are more likely to have larger and more progressive curves.

Idiopathic scoliosis is not associated with abnormalities of the vertebrae or the neurologic system.

There are three classifications:

Infantile: Birth to 3 years old

Juvenile: 4 to 10 years old

Adolescent: Older than 10 years old

Obviously, there is overlap among the types, but adolescent is the most common.

Adolescent scoliosis is present during a period of rapid growth. If a curve is destined to get worse, it usually does so during the adolescent growth spurt. The prediction of how a curve will behave is dependent on the degree of maturity of the skeleton at the time of diagnosis.

For girls, the start of menstrual periods is one of the markers of skeletal maturity and is helpful in predicting behavior of the curve. Other indicators of skeletal maturity are seen on the scoliosis x-rays and bone age films.

Scoliosis is diagnosed by a physical exam and confirmed and quantified by x-rays. Physical exams during well-child pediatrician visits can detect abnormal shape of the back, especially a hump that is seen on forward bending.

However, often a parent will notice that their child’s back looks crooked and will bring that to the attention of the pediatrician. X-rays of the back with the person standing is the standard way of confirming the diagnosis.

Once the diagnosis is confirmed, referral to an orthopaedic surgeon with special training in spinal deformity is in order.

Decision making regarding need and type of treatment is complicated and requires a good deal of knowledge about scoliosis so that the correct treatment is chosen, and unnecessary treatment avoided.

For the usual case of idiopathic scoliosis, advanced imaging like MRI and CT are not needed unless there is suspicion of an underlying spinal cord abnormality or, in severe cases, for surgical planning.

Each curve has its own natural history, which is how the curve will behave without any intervention. For many children with idiopathic scoliosis, a time of observation with periodic x-rays is all that may be needed.

There are only two treatments that are effective: bracing and surgery.

If a curve demonstrates worsening or is already between 25-to-40 degrees in a child with at least two years of growth remaining, then bracing is the preferred treatment. Brace treatment is not indicated in those who are skeletally mature or for curves greater than 40-to-45 degrees.

Once bracing is started, it must continue until skeletal maturity as determined by bone age x-rays. It is important to note that bracing prevents further worsening. It does not affect lasting correction of the curve or improvement of other cosmetic abnormalities.

If the curve is too large for bracing, then surgery may be needed. As opposed to bracing, the surgery does correct the curve and associated cosmetic deformities.

The usual surgery is a spinal fusion, or “welding” the vertebrae together with bone graft and correcting the curve with screws or hooks inserted into the vertebrae, which are connected to rods.

This operation will permanently correct the curve and prevent any worsening. There are some other types of operations that can be done in place of spinal fusion, but their effectiveness has not been entirely proven.

Bottom line – when the diagnosis of scoliosis is made, don’t panic.

Careful evaluation by a knowledgeable orthopaedic surgeon will provide advice on the best way to manage an individual’s scoliosis. This may consist of only reassurance that the scoliosis is mild, and nothing needs to be done, or, in the severe case, surgical treatment may need to be discussed. Shared decision making between the surgeon and the family is essential for the best outcome.

WVU Medicine Children’s pediatric orthopaedic surgeons, anesthesiologists, pediatricians, and support staff can provide up to date and state of the art treatment for all types of scoliosis.