Scoliosis is very treatable, and while it may not be completely cured, early treatment can reduce the need for surgery and prevent a spinal curve from getting worse. When detected early, there are more options for controlling a curve. Even in cases where the curve becomes apparent in adolescence or adulthood, treatments can relieve pain and even breathing difficulties that can come with advanced scoliosis.
For many children with scoliosis, treatment begins with simple monitoring. If the spinal curve is small and not increasing as your child grows, no further treatment may be needed. This approach requires regular observation and measurements to track the progress of the spinal curvature. Mild scoliosis, often in adolescent idiopathic scoliosis (scoliosis with no known cause), warrants this approach.
Monitoring includes routine physical examinations and periodic imaging, such as X-rays. Norton Children’s Leatherman Spine uses the EOS Imaging low-dose radiation system to expose children to less radiation while observing any scoliosis progression.
Monitoring aims to determine if the scoliosis is stable or worsening, and guides decisions on whether physical therapy or potential spinal surgery is necessary. This approach helps in tailoring a treatment plan based on the child’s specific needs and the progression of the spinal curve.
While your child can’t grow out of scoliosis, monitoring can determine whether a curve stays mild and doesn’t need more aggressive treatment. If it progresses during adolescent growth spurts, bracing or even surgery may be necessary.
In most instances, only monitoring is required for curves less than 20 degrees in younger patients or larger curves in mature teenagers.
Scoliosis bracing is a common nonsurgical treatment primarily for children and teens with idiopathic scoliosis, the most common type of scoliosis. Bracing can halt the progression of a spinal curvature while your child is growing. Depending on the severity of the curve and the child’s age, braces may be worn for 16 to 23 hours a day or just at night for 8 to 10 hours.
Bracing has been shown to be up to 75% effective in growing teens at preventing curves of 20 degrees to 45 degrees from progressing to the point of requiring surgery.
Braces are designed to put pressure on the outside of the spinal curvature while allowing the inside of the curve to move toward a straighter position. To control scoliosis, a brace must be worn until a child reaches skeletal maturity – around age 16 for girls and 18 for boys.
Braces have advanced to less bulky, custom-fitted structures that can be concealed easily under clothing. Today’s braces are designed to be less noticeable, increasing the likelihood that they’ll be worn.
Most braces are made of lightweight, hard plastic and fit around the torso from below the armpits to just below the waist.
The Boston brace is a widely used device that applies pressure to three specific points along the spine to correct sideways curves and encourage a straighter spine as it grows. Scoliosis-specific exercises accompany the bracing to improve the straightening and maintain spinal flexibility.
The Chêneau brace is custom made for the patient and uses strategically placed pads and open spaces that exert pressure on specific areas of the spine while allowing room for growth and movement. The brace is designed to correct slight twisting, or rotation, of the spine as well as encourage straightening during growth.
Bracing can be highly successful in preventing curve progression, especially when worn consistently as prescribed. Success is greater when initiated early in the curve’s progression. While it may not completely “fix” scoliosis, it often achieves the goal of avoiding the need for surgical intervention.
Casting is a treatment option for very young children, ages 1 to 4, with a curve of 35 degrees or more. Applying a plaster cast to the child’s torso can slow the progression of a spinal curve and possibly straighten it enough to prevent the need for surgery as they get older.
The cast, applied under general anesthesia, needs to be replaced every two to four months to accommodate growth and may be necessary for years to correct the curvature. Bracing may follow once the cast is removed.
From sideways to straight: Bailey’s journey through spinal surgery back to the soccer field
The Schroth Method is a nonsurgical option for scoliosis treatment. It uses customized scoliosis-specific exercises that can address a lateral curve and any twist or rotation in the spinal column.
The aim is to strengthen muscles in specific areas so they supplement or even take the place of a brace.
Initially, the child meets with a therapist once a week for three to four months or longer. With progress, visits can drop to twice a month, and then once a month until skeletal maturity at around age 16 for girls and 18 for boys. This treatment includes 20 to 30 minutes of daily home exercises.
Schroth exercises may involve sitting, standing, and lying on the back, stomach or side. Patients may use wall bars, poles or exercise balls to assist with positioning their arms and legs. Children will use passive correction, beanbag exercises with different positions and wall hanging to help elongate the spine.
Parents and caregivers are encouraged to participate in the child’s Schroth Method therapy. Parents can take photos and videos of sessions to help with home practice and setup with the various equipment and positions. Family support is crucial for children to succeed with home exercises.
The Schroth Method can be used to treat adults and children with idiopathic or neurological scoliosis. Idiopathic scoliosis is scoliosis that does not have a known cause; it is the most common form. Neurological scoliosis is caused by a neurological or muscular condition.
Patients with severe scoliosis who aren’t candidates for conservative scoliosis treatment, such as monitoring, bracing or physical therapy, may need surgical treatment. Spinal surgery can stop the curve from worsening and often significantly improves the severity of the curve.
Surgery is recommended for curves that are progressing rapidly in young patients with significant growth left in the spine, when bracing hasn’t addressed the progression or if the size of the curve is 45 degrees to 50 degrees in the chest area or 35 degrees to 40 degrees in the lower back.
VerteGlide is a revolutionary new scoliosis surgery pioneered at Norton Children’s Leatherman Spine. VerteGlide uses rods to straighten the spine, but unlike spinal fusion, the vertebrae are allowed to move along the rods as the child grows — much like curtains gliding along a curtain rod.
The procedure could dramatically reduce the number of surgeries children need and give them a childhood defined less by trips to the hospital.
Like traditional scoliosis surgery, the system involves surgical implantation of two rods in the child’s back parallel to the spinal column. Unlike traditional growing rods, the vertebrae that surround the spinal cord aren’t fixed to the rods with typical screws. The spine is attached with screws that allow it to slide along the rods as the child grows naturally.
The spine can move up and down the rods on its own as the child gets taller, without needing doctors to adjust anything.
With traditional growing rods, children typically need surgery every six months to adjust the rods as they grow. That means multiple hospital visits, repeated anesthesia and a childhood filled with medical procedures.
With VerteGlide, most children only need two surgeries: one to place the system and one when they’re done growing to take it out and perform traditional fusion to help prevent progression.
This minimally invasive surgical technique works with a child’s natural growth process to correct their spinal curvature over time.
During a tethering surgery, several screws and a tether are placed along the spinal curvature. As a child grows, the tether will guide the spine into straightening. Surgeons perform the procedure by making small incisions and using an endoscopic camera.
Children can return to school within a couple weeks and resume their normal activities within a few months. They also may participate in sports and other activities with fewer, if any, restrictions after recovery.
Tethering should be performed when a child’s spine is still growing, usually between ages 10 and 15. It can be performed in the upper back (thoracic spine) or lower back (lumbar spine).
Growing rods and magnetic rods are alternatives to spinal fusion for children with early onset scoliosis.
Growing rods are placed inside the muscle adjacent to the spine. Because they are only attached to small areas above and below the curve instead of the whole curve, they don’t interfere with the spine’s growth. The rods are lengthened surgically about every six months.
Another approach surgically attaches telescoping rods to the spine like traditional growing rods, but they are lengthened differently. Using an external magnetic device every few months, the rods are activated to extend 3 to 5 millimeters to keep up with a child’s natural growth rate. The extension is done in the orthopedist’s office and is so slight the child doesn’t feel it.
Magnetic rods can telescope only so far, so they’ll need to be replaced periodically, but not as frequently as growing rods that can’t be lengthened.
Growing rods have been the standard of care for decades for children who don’t respond to bracing or casting. But the need to lengthen the rods or replace them until the child’s skeletal system matures can mean 10 or more surgeries followed by a spinal fusion operation.
This surgery generally is performed in children who have reached skeletal maturity, around age 16 for girls and 18 for boys, and adults. The procedure involves fixing metal rods to either side of two or more vertebrae to straighten the spine. Bone grafts are used to fuse the vertebrae together. The parts of the spine that are fused will stop growing.
After six months to a year, the bone grafts will have secured the targeted vertebrae into one bone, and while the rods are no longer necessary, there’s no reason to undergo another surgery to remove them.