Orthopedic Surgery

Idiopathic Scoliosis

Idiopathic scoliosis is the most common spinal deformity in the world. Unlike other forms of scoliosis that have a known or defined cause, the origins of idiopathic scoliosis remain largely a mystery.

Through much research — including much at The Children's Hospital of Philadelphia — we have discovered idiopathic scoliosis seems to have a genetic component. But continued research is needed to identify the specific genes and genetic markers for idiopathic scoliosis, a condition that affects as many as 3 in every 100 Americans.

Like other forms of scoliosis, idiopathic scoliosis affects the curvature of the spine. Instead of a straight line down the middle of the back, a spine with scoliosis curves and sometimes looks more like a letter “S” or “C,” rather than a straight “I.” The spine also can be rotated or twisted, pulling ribs along to form a multidimensional curve. Scoliosis is a deformity of the spine and should not be confused with poor posture.

Idiopathic scoliosis usually occurs in adolescents 10 to 18 years of age, but can occur in younger children, and is seen more often in girls. If a baby or young child (under age 8) is diagnosed with idiopathic scoliosis, it is generally classified as infant scoliosis or juvenile scoliosis, both forms of early-onset scoliosis

Symptoms of idiopathic scoliosis

Mild idiopathic scoliosis does not usually cause any symptoms. Parents and children may primarily be concerned about the cosmetic appearance of the back.

The most common symptoms of idiopathic scoliosis are:

* Traditionally, scoliosis is described as a nonpainful condition. If your child does have pain associated with any of the symptoms listed above, a comprehensive orthopedic workup is recommended as soon as possible.

Evaluation and diagnosis of idiopathic scoliosis

Early detection of idiopathic scoliosis is important for successful treatment of curves. At The Children's Hospital of Philadelphia, a trained pediatric orthopedic physician will perform a complete medical history, a physical examination and a visual evaluation of the curvature of your child's spine. 

Imaging tests take a closer look at your child's spine to see if there are any problems with the bones and to measure what degree of curvature is present.

X-rays are one of the primary diagnostic tools for idiopathic scoliosis and show the precise angles of curvature in 2-dimensional pictures.

If the curve pattern is not typical or if there is something unusual in the X-ray, a physician may order one or more of the following tests to provide more detail:

Individualized, collaborative treatment

At CHOP, we practice collaborative, family-centered care. A team of expert clinicians — including leading orthopedic physicians and surgeons, pediatric nurses, physical and occupational therapists, psychologists and other specialists — will partner with you in the care of your child.

The team is led by orthopedic surgeon John P. Dormans, MD, FACS, chief of the Division of Orthopedic Surgery. Dr. Dormans has developed numerous innovative surgical techniques for use in spine surgery and led many studies in the area of scoliosis and pediatric spinal deformities. He is also a member of the presidential line for the Scoliosis Research Society, an international organization dedicated to education, research and treatment of spinal deformities.

CHOP's spine team includes leading pediatric orthopedic surgeons including:

Together, we treat children with all types of scoliosis — from mild to the most severe.

Every spine condition is different, so treatment is determined on a case-by-case basis. In planning your child's individual treatment, our team of specialists will consider the severity of the curve, where it occurs in the spine, and your child's age and stage of growth.

Nonsurgical interventions

Many patients with mild scoliosis do well without surgery and may only need to be regularly observed and monitored by a physician to make sure the curve doesn't worsen. Monitoring may include regular observation, X-rays and lab tests.

For a child with a spinal curve less than 25 degrees, ongoing monitoring by a pediatric orthopedic doctor is generally recommended. If doctors document the child's spinal curves are worsening, back bracing may be recommended. 

Back braces, halo vests and other bracing devices are often the first line of defense against a child's worsening spinal curves caused by idiopathic scoliosis. By immobilizing the child's spine, the hope is that the spinal curve will not get progressively worse and that any associated pain will be controlled. If bracing is successful, it may delay or, in some cases, avoid the need for spine surgery in some children.

At CHOP, orthopedic physicians work closely with the National Orthotics and Prosthetics Company (NOPCO) to fit patients with custom-designed other braces. Because NOPCO has a local office at CHOP, these braces can be measured, created and fitted in a short period of time.

Orthotic braces reduce pressure on your child's lower back and help straighten his or her spine. The brace should be worn most of the time for optimal results. Your child's physician will give your specific instructions to best aid your child's condition.

For children with spinal curves between 25 and 40 degrees, treatment may include back bracing or spinal surgery. For children with curves of 40 degrees or greater, surgery is almost always indicated.

Surgical interventions

The most common surgical interventions for idiopathic scoliosis are spinal fusion and implanting growing rods. The determination of which surgery is right for your child will depend on your child's age and skeletal maturity, along with a host of other medical considerations.

Each patient is evaluated individually and treatment recommended based on your child’s long-term health needs. 

Spinal fusion

If your child has stopped growing — or if growing rods are not considered a viable treatment option — spinal fusion surgery may be recommended to permanently stabilize your child's spine.

In this procedure, the abnormal curved spinal bones may be realigned, fused together and metal implants inserted to correct the curvature.

Growing rods

For children who are still developing (younger than age 12 for girls or age 14 for boys), growing rod surgery is generally the preferred treatment. The surgery is performed through the back of the spine.

In most cases, the curve in the child's back is spanned by one or two rods under the skin to avoid damaging the growth tissue of the spine. The rods are attached to the spine at two spots — above and below the curve.

After surgery, your child will return to the Hospital every six months to have the rods expanded or "lengthened" to keep up with your child's growth and continue straightening the spine. 

Another option: VEPTR

If your child is still growing and the spinal curve is affecting rib and lung development, your child may also be diagnosed with thoracic insufficiency syndrome.

If this is the case, an innovative surgical device called vertical expandable prosthetic titanium ribs (VEPTR) may be recommended by your child's orthopedic physician. VEPTR stabilizes the curved spine and allows your child’s ribs, spine and lungs to expand and grow. 

Like growing rods, VEPTR is surgically adjusted as your child ages and reaches full skeletal maturity.

Safety in spine surgery

Surgery can dramatically improve the long-term outcomes for your child with idiopathic scoliosis, but it can also be a stressful experience for you and your child. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Some safety protocols our orthopedic surgical team uses include:

To learn more, read how we make safety in surgery a top priority.

Follow-up care for idiopathic scoliosis

If bracing is required as treatment for idiopathic scoliosis, your child will be re-evaluated every six months until your child's condition is stable. If bracing is recommended as a temporary treatment leading up to spinal surgery, your child will be evaluated regularly before and after surgery until your child's condition is stable. After your child's spine is stabilized, annual visits to an orthopedic healthcare provider are recommended.

If your child received growing rods or VEPTR, an additional surgery — spinal fusion — may be necessary when your child has finished growing.

At The Children's Hospital of Philadelphia, we offer a wealth of ongoing support and services for patients and families at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and other caregivers to provide the most current, comprehensive and specialized care possible for your child.

We recognize that your child's pediatrician is an important part of the clinical team and provide regular updates on your child's progress. If continued care and monitoring is necessary long-term, we will help transition your child's care to an adult orthopedic team.

Long-term outcomes for idiopathic scoliosis

Almost all children with surgically corrected idiopathic scoliosis do well and lead active, healthy lives. When clothed, most show no visible signs or symptoms of scoliosis five years after surgery.

Research into idiopathic scoliosis

Clinicians at The Children's Hospital of Philadelphia are actively researching a range of spinal deformities. Physicians and staff in the Division of Orthopedic Surgery at CHOP are actively involved in nearly 100 orthopedic research projects — the majority of which address some aspect of the diagnosis or treatment of scoliosis.

Orthopedic doctors regularly collaborate with The Center for Applied Genomics at CHOP, one of the world's largest genetics research programs and the only center at a pediatric hospital to have large-scale access to state-of-the-art throughput genotyping technology.

Recent research at CHOP, led by Struan Grant, PhD, associate director of the Center for Applied Genomics, identified a gene mutation as a potential cause of idiopathic scoliosis. The research won a Hibbs Award from the Scoliosis Research Society, an international organization dedicated to the education, research and treatment of spinal deformities.

With research, orthopedic leaders at CHOP hope to be able to predict spine conditions and treat them before many of the symptoms begin.

Resources

To learn more about idiopathic scoliosis and treatment options, visit:

Contact us

To make an appointment with the Division of Orthopedic Surgery at The Children's Hospital of Philadelphia, call 215-590-1527 or contact us online

Reviewed by: John M. Flynn, MD, and John P. Dormans, MD, FACS
Date: January 2013

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