A comprehensive physical examination is required to diagnose scoliosis. During this exam, the physician will ask the child to bend forward in order in reveal any deformities. The doctor will also check for any discrepancies in limb length, abdominal muscle strain and other potential problems. If there is any indication of scoliosis, it will be confirmed with an X-ray to measure the degree of the curve of the spine.

Individualized treatment is then planned, based on the severity of the curve, the age when the curve began, the time until skeletal maturity and the location of the curve. According to the Scoliosis Research Society, curves of the upper spine are more likely to progress than middle or lower spine curves. The majority of children with scoliosis may not need complex care, but each case must be evaluated.

If a curve does progress, an orthopedic brace can be used to prevent it from getting worse. If a severe curve is discovered or if a brace does not control a small curve, surgery has been found to be a highly effective and safe treatment. Electrical muscle stimulation and manipulation have not been proven as effective treatments for scoliosis.

Scoliosis with curves exceeding 45 degrees can cause long-term problems if left untreated. Deterioration of the curve can get progressively worse and may lead to back pain, diminished heart and lung capacity, or restrictive lung disease. Cosmetic and lifestyle concerns can also be significant.

Observation
Continued observation is appropriate for mild curves of less than 20 degrees or if the child is near skeletal maturity. Most often, the child will simply need to return for an examination and X-rays three to six months later to check for any change in their condition.

Physical Therapy
A physical therapist often works with children who suffer from scoliosis to lessen pain and inflammation and improve mobility and strength. Although exercise does not change the curves of scoliosis, it can help maintain flexibility, especially in the hamstrings and low back. Many children find it helps enhance their everyday activities. The goals of physical therapy are to improve back posture, encourage aerobic fitness, maximize strength and help manage the symptoms of scoliosis.

Bracing
The goal of bracing is to prevent curves from progressing and can be effective if the child is still in a growth stage and has a curve of less than 45 degrees. Our orthopedic specialists will recommend the most effective type of brace and how long it should be worn each day. Children undergoing treatment with orthopedic braces are encouraged to keep acting like kids. They are even able to participate in physical and social activities without their brace, if it is worn for the required amount of time throughout the rest of the day.

Surgery
Surgery is an option in cases of continual pain, difficulty breathing, considerable disfigurement, a progressively worse curve and curves of more than 45 degrees. The main surgery used to treat scoliosis is called spinal fusion with instrumentation. It involves a bone graft from the hip, ribs or a bone bank. Additionally, a series of rods, hooks, screws or wires is used to straighten the spine. This surgery can be performed in a variety of ways, including through the front, back or a combination of the two. The type of surgery used depends on age, mobility of the spine, location and degree of the curve, and any pressure on the nerve roots of the spine.

Anterior Instrumentation
This spinal fusion procedure is performed through the front with a small incision made in the chest. Intervertebral discs are removed from the area of the curve to make the spine flexible. Next, screws placed in the vertebrae are connected by a metal rod. A bone graft inserted in place of the removed discs causes these vertebrae to fuse together. Then the screws attaching the metal rod are tightened, straightening the curve of the spine.

Posterior Instrumentation
This procedure is performed through the back. Hooks, screws or wires are attached to the spine as anchors. These anchors are attached to metal rods that straighten the spine. Bone grafts fuse the affected vertebrae in place.

Combined Anterior and Posterior Approach
In some cases, more than one type of procedure may be necessary. This combined approach uses one surgery through the front and another through the back to straighten the spine. These operations may be performed on separate days or as part of one longer surgery.

Which approach is right for my child?
With any severe condition or illness, your family deserves the most advanced care possible. Getting a second opinion is an easy and effective way to ensure that your child receives the treatment that is best suited to their needs.

To get a second opinion from a Medical City physician, please call 972-566-4566.