Scoliosis is a relatively common spine condition that affects many young children and adolescents. It is a sideways curvature of the spine. Instead of a straight line down the middle of the back, a spine with scoliosis curves sometimes looks more like the letter "S" or "C," rather than a straight "I." The spine may also be rotated or twisted, pulling the ribs along with it to form a multidimensional curve.
An equal number of boys and girls have scoliosis, but it is most common for girls to have a type of scoliosis that requires some treatment.
Scoliosis is a type of spinal deformity and should not be confused with poor posture. It cannot be prevented, but may be treated.
There are several different types of scoliosis:
Idiopathic scoliosis is the most common type of scoliosis, usually occurring in adolescents and more often in girls than boys. Use the links above to learn more about the symptoms, treatment options and outcomes for specific forms of scoliosis.
The pathology of each form of scoliosis is unique. For example, congenital scoliosis is caused by one of the bones in the spine being abnormally shaped at birth. Neuromuscular scoliosis is associated with an underlying nerve and muscle condition.
Idiopathic scoliosis and early-onset scoliosis (which is essentially idiopathic scoliosis that occurs in younger children as opposed to adolescents) have no known cause, although genetics do play a role.
Orthopedic clinicians at The Children's Hospital of Philadelphia are actively researching the full range of spinal deformities. The Division currently has almost 100 open research studies — the majority of which focus on some aspect of scoliosis. CHOP orthopedic physicians and staff are leading or participating in numerous multi facility clinical trials; some of which is funded by the National Institutes of Health.
Orthopedic clinicians regularly collaborate with The Center for Applied Genomics at CHOP, one of the largest genetics research programs in the world 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 to identify a gene mutation as a potential cause of idiopathic scoliosis 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.
Common symptoms include:
If your child has a severe form of scoliosis that affects the size and shape of the rib cage, he or she may experience pain or discomfort. But most children with scoliosis do not feel physical pain from the condition. If your child does feel pain, schedule an appointment with a physician for an evaluation.
Because scoliosis may affect your child’s outward appearance, it can hurt his self-esteem or self-image. At CHOP, we have psychologists, social workers and other support services available to provide important emotional support to your child. Talk to your clinician for more details.
A doctor confirms scoliosis by conducting a thorough medical history, performing a physical exam and observing X-ray results.
The physician may also order the following diagnostic procedures to gain more information and detail about your child's spinal curve:
At The Children's Hospital of Philadelphia, we practice family-centered care that is customized to your child and family. Our pediatric clinical experts collaborate to provide the best care for your child. Our multidisciplinary team includes leading orthopedic physicians and surgeons, neurologists, rehabilitation physicians, pediatric nurses, therapists and many other specialists.
In planning your child’s treatment, our team considers the severity of your child’s curve, where it occurs in the spine, and your child’s age and skeletal development. Treatment depends on the severity of the curve and whether or not it is getting progressively worse as your child grows.
Most patients with mild scoliosis do not need treatment, just regular monitoring by a physician to ensure the curve is not getting worse.
Each child’s care is unique, but some general rules apply in most cases.
The most common surgical interventions are implanting growing rods (for children who are still growing) or a spinal fusion (for children who have reached skeletal maturity or for whom growing rods are not a consideration).
Growing rod surgery is done 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.
When your child is fully grown, a spinal fusion may be performed to provide a permanent solution to your child's spinal condition.
During the spinal fusion operation, the deformed section of the spine is straightened using metal rods and the corrected position is made permanent with a spinal fusion. Bones in the back 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 corrected position while the bone graft heals. The extra bone from the hip or pelvis helps the bones knit together.
A third surgical option may be recommended if your young child is still growing and the spinal curve is affecting rib and lung development. This condition, called thoracic insufficiency syndrome, may be treated with vertical expandable prosthetic titanium ribs (VEPTR), a unique and patented “growth sparing” device developed by one of CHOP's leading orthopedic surgeons.
Talk to you child's orthopedic physician about the best course of treatment — whether surgical or nonsurgical — for your child.
Your clinical team will monitor your child’s progress at regular intervals, which taper off to annual visits after your child's condition stabilizes. We can treat your child at our Main Campus in Philadelphia or at a CHOP Care Network location near you. We also update your child’s pediatrician or referring physician about your child’s progress. If continued care is necessary as your child becomes an adult, we will help transition your child's care to an adult orthopedic team.
Children usually can return to school a few weeks after spinal surgery, but lifting heavy objects such as backpacks and bending or twisting is discouraged for several months.
Orthopedic specialists have not found any specific exercises that might prevent scoliosis. There may be some activity restrictions for one to two years after a spinal fusion, but patients are encouraged to resume regular exercise for general health.
The earlier scoliosis is detected, monitored and, if necessary, treated, the better the outcome. Most children treated for scoliosis can have outstanding results and achieve normal or near-normal function.
The Children's Hospital of Philadelphia is dedicated to patient education and has produced a series of instructional videos about scoliosis and spinal surgery.
To learn more about spinal surgery for scoliosis, watch Straight Talk: Understanding Scoliosis and Thoracic Insufficiency Syndrome.
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: Denis S. Drummond, MD
Date: January 2013