Health Information

Scoliosis FAQs

What is scoliosis?

When you look at a person from the side, it is normal to see some curves in the spine. The curves of the low back and of the neck point forward while the curve of the upper back points backward.

Scoliosis is a sideways curve of the back that can be seen when we look at your child from behind. Unfortunately, it is hard for a child to see this curve. However, you may have noticed that one hip or shoulder is higher than the other, or that your child’s waist seems to be thicker on one side than the other.

We can also see scoliosis when a child bends forward and tries to touch his or her toes. Although the sideways curve might be abnormal, we do not call it a true scoliosis until the curve measures more than 10 degrees on an X-ray.

An equal number of boys and girls have scoliosis, but it is most common for girls to have a scoliosis that requires some treatment.

If my child doesn’t feel any pain, does he or she still have scoliosis?
 
People with scoliosis are active, and it is unusual for a young person with scoliosis to have back pain. If your child has severe back pain, we may need to do more studies to find out the cause of the pain.

What causes scoliosis?

We really don't know the cause of scoliosis. That's why the most common form if it is called "idiopathic." That means there is no known reason for the condition. It may be passed on from generation to generation through the genes, but not every person with scoliosis has a family member with scoliosis. As far as we know, carrying a book bag — even a really heavy one, even on the same shoulder all the time — will not cause scoliosis. There is also no evidence that bad posture causes scoliosis.

Are there any exercises that can prevent or control scoliosis?

We do not know of any exercises that will make a difference to scoliosis. Orthopaedic doctors have looked for exercises that might help, but they haven't found any. But we do think it's a good idea for all people to be active and exercise regularly for their general health.

Why do we have to treat scoliosis?

Small curves don't seem to cause any big problems later in life. But if the curve is big enough, it can cause problems with breathing or moving around. It could cause back pain. And it certainly could affect your child’s appearance. A curve that is bigger than 50 degrees will continue to get bigger — slowly but surely. That's why we need to treat your scoliosis when your child is young. It’s an investment in his or her future health.

Our child is 12. When should his/her scoliosis be treated?

Scoliosis is most likely to progress during the growing years. The curve has to be watched carefully during the growth spurt that takes place just before and during puberty. Your child will need to see us for check-ups and X-rays to see if the scoliosis is changing. Curves that are bigger than 50 degrees will continue to get worse, even after he or she has stopped growing.

Our goal is for your child to reach adulthood with a good appearance and a scoliosis curve less than 50 degrees.

How do we treat scoliosis?

Treatment for scoliosis depends upon the size of the curve and whether or not it is getting bigger. We take X-rays at set intervals to measure the curve and see if it is getting progressively bigger.

There have been many treatments tried to control scoliosis, including special exercises, electrical stimulation and diets. Doctors who treat scoliosis have found that the following treatments are successful:

Observation

CHOP orthopaedic surgeons carefully watch curves that are less than 20 degrees on X-rays. Some will not get bigger or cause any future problems. If your child reaches full growth with a small enough curve (less than 30 degrees), there is very little chance the curve will get bigger when he/she becomes an adult. But some small enough curves do get worse, especially when children are still growing. If the curve gets bigger than 25 degrees, we will probably start to treat the scoliosis.

Bracing

If the curve is bigger than 25 degrees and getting bigger, a brace will be needed. A brace is a hard plastic jacket, which will be made especially for your child’s body. It pushes the spine to make it straighter, but it doesn't hurt. The brace is worn 20 hours per day. Children can plan their time out of the brace so that they don't have to wear it for sports, dances or special events.

 There are no activities that cannot be done while wearing a brace. The brace has a big chance — as much as 80 percent — of preventing from the scoliosis from getting worse, but only if it is worn!

We try to stop the curve from getting bigger, but we can't make the curve go away altogether or get smaller with the brace. We hope that the curve your child has when he or she starts wearing the brace will be the same curve he/she has when their growing stops. You may see the curve getting smaller as we check the X-rays along the way, but this is usually a temporary change.

Surgery

Surgery may be recommended if your curve progresses beyond 45 to 50 degrees. Factors considered for recommending surgery include how mature your child’s bones are and the curve's rate of progression.

 The operation is called a spinal fusion. During the operation, the bones in the back (the vertebra) are joined together with bone taken from the hip bone or pelvis. Metal rods are placed alongside of the spine to hold the bones in a straight position while the bone graft heals. The extra bone from the hip or pelvis helps the bones knit together.

A spinal fusion will not make the spine perfectly straight, although it will be straighter than it was before the operation. The main purpose of the operation is to stabilize the curve and prevent your scoliosis from getting worse.

After the operation, some children have to wear a cast or brace to help support the spine while it heals. There are also some activity restrictions for one to two years after the operation. You will receive detailed instructions about sports and activities after the operation.

How long will my child be hospitalized?

For adolescent patients, hospitalization generally lasts five to six days. When all of the goals to prepare a patient for independent care at home have not been reached, a hospital stay can extend to seven days.

How long are patients out of school?

Usually three to four weeks are needed to prepare a child or teenager for total independent activity at school. At home, rehabilitation is usually combined with home education so that students can keep up with their school work and studies. Your child's school can advise you on how to arrange for this service.

How many visits to the surgeon's office are needed after surgery?

In the first year, we recommend three visits:

• Six weeks after surgery
• Six months after surgery
• One year after surgery

After that, annual visits are required.

Are there special instructions to follow to make hospital and home care easier?

Yes. We have designed a pre- and postoperative regimen to follow a standard routine, that we call a critical pathway. The guidelines are established so that nothing is missed, and the tasks for the caregivers, including the parents, are clear and manageable. We will explain these guidelines when your child is scheduled for surgery.

When can my child return to normal physical activities, including sports?

Your surgeon will tell you when your child or teenager can return to normal activities. Generally, activities are progressively increased over the first year after surgery. After this point most patients can re-enter most competitive sports. In fact, we encourage such activity.