Testing and diagnosis of idiopathic scoliosis

How is idiopathic scoliosis diagnosed?

Early detection of idiopathic scoliosis is important for successful treatment of spinal curves and the best long-term results for your child. At CHOP, 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 (X-rays) will take a closer look at your child’s spine to see if there are any problems with their bones and to measure what degree of curvature is present. X-rays are the primary diagnostic tool for idiopathic scoliosis and show the precise angles of curvature in two-dimensional pictures.

If the curve pattern of your child’s spine is not typical or if there is something unusual in the X-ray, your child’s physician may order one of the following tests to provide more information:

• EOS imaging, is a low-dose, 3D imaging system that scans your child standing up. An EOS scan shows us your child’s natural, weight-bearing posture and allows us to see how the joints interact with the rest of their musculoskeletal system, especially the spine, hips and legs. EOS uses a fraction of the radiation dose that a general X-ray uses, which is especially beneficial for patients with scoliosis that may require frequent imaging. CHOP was the first institution in the U.S. to introduce “EOS micro-dose” for use in scoliosis follow up. Micro-dose uses one-third of the standard EOS radiation dose. This imaging can be performed on patients age 5 years and older.
• Magnetic resonance imaging (MRI) uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures inside the body. An MRI does not expose your child to radiation.
• Computed tomography (CT) scan uses a combination of X-rays and computer technology to produce cross-sectional images (“slices”) of the body. CT scans are helpful in detecting ribcage problems.

Treatments for idiopathic scoliosis

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

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.

Non-surgical scoliosis interventions

Many patients with mild idiopathic scoliosis do well without surgery and may only need to be regularly monitored by a physician to ensure their curve doesn't worsen. Monitoring may include regular observation and X-rays.

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

Back brace for idiopathic scoliosis 

Back braces are the first line of defense against a child’s worsening spinal curves caused by idiopathic scoliosis. When properly made and worn as instructed, a brace can hold the curve in a (partially) corrected position, preventing progression of the deformity. 

The goal of bracing is to prevent the progression of scoliosis as your child grows. The brace is designed to help correct the spine in three dimensions (3D bracing). Bracing helps guide the spine into a better position while your child is still growing and wearing the brace. It should be worn most of the time (16-20 hours a day) for best results.

Recent studies, including the NIH-funded BrAIST trial conducted at CHOP and other major scoliosis centers, proved that braces are very successful in halting the progression of scoliosis. 

Braces are generally used for spinal curves between 25 and 45 degrees in children with significant growth remaining. In rare circumstances, bracing is used in larger or smaller curves. When scoliosis exceeds 45-50 degrees, surgical correction is usually necessary.

Back bracing may also be recommended as treatment leading up to – or immediately after – spine surgery.

Surgical interventions for idiopathic scoliosis

There are several surgical options to correct idiopathic scoliosis. Doctors will evaluate your child and determine which surgery is right for your child based on your child’s long-term health needs, their age, skeletal maturity, and several other medical considerations.

Spinal fusion

If your child is in the final 2-3 years of growth or has finished growing, spinal fusion surgery may be recommended to correct the deformity as much as possible. This surgery permanently stabilizes your child's spine.

During spinal fusion surgery, the abnormal curved spinal bones are realigned and fused together. Metal implants are also inserted to correct the curve.

Growing rods

For children who have many years of growth remaining, a growth-friendly option is preferred. In growing rod surgery, the curve in your child's back is spanned by one or two rods next to the spine. The rods are attached to your child’s spine and vertebrae above and below the curve. The growing rods help guide spinal growth and drive the spine straight.

As your child grows, they will return to CHOP regularly, often every 6 to 12 months for outpatient surgery to expand the growing rods. This approach minimizes spinal deformity, maximizes spine growth and allows continued lung development as your child grows.

Our surgeons have pioneered the use of magnetically adjustable growing rods. These rods can be adjusted in the doctor’s office without the need for surgery or general anesthesia. This technology has greatly reduced the number of surgeries that growing rod patients require

Vertebral body tethering

Our surgeons were among the first to perform vertebral tethering surgery. Learn more about this experimental surgical treatment.

VEPTR

If your child is still growing and the spinal curve is affecting rib and lung development, your child may also be diagnosed withthoracic insufficiency syndrome (TIS), a rare condition.

If this is the case, an innovative surgical device called the vertical expandable prosthetic titanium rib (VEPTR) – developed by the late Robert M. Campbell Jr., MD, once one of CHOP’s leading orthopedic surgeons – may be recommended. 

VEPTR straightens the spine and expands the space available for your child’s lungs and other internal organs to grow. VEPTR devices can be attached to your child’s spine, rib, or pelvis, and multiple devices can be implanted depending on your child’s individual needs.

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 that can help you and your child prepare for surgery.

Additionally, we follow many best practices before, during and after surgery, to decrease the risk of infection and increase positive outcomes. Our safety protocols have been so successful that they have been adopted by many other children’s hospitals around the world. Some safety protocols our orthopedic surgical team uses include:

• A strict antibiotic protocol before we operate
• The use of innovative navigation and imaging equipment during surgery, like StealthStation® and O-arm® Surgical Imaging
• Continuous monitoring of your child’s anesthesia during surgery, including specialized spinal cord monitoring
• Procedures after we operate (postoperative clinical pathways) to ensure quality standards, and rapid patient recovery

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

Follow-up care for idiopathic scoliosis

If we recommend spine bracing for your child, we will re-evaluate them every six months until their condition is stable. If we recommend bracing treatment leading up to spine surgery, we will evaluate your child regularly before and after surgery until their condition is stable. After your child’s spine is stabilized, we recommend annual visits to an orthopedic healthcare provider.

If your child received traditional growing rods, magnetic growing rods or VEPTR treatment, we may recommend an additional surgery – such as spinal fusion – when your child has finished growing.

If your child receives vertebral body tethering, the screws and cable used will not need to be removed or adjusted in most cases.

After treatment — whether surgical or nonsurgical — your CHOP orthopedic team will continue to follow up on your child’s care at our Philadelphia Campus or one of our CHOP Care Network locations. We offer a wealth of ongoing support and services for your child and family, and we are committed to partnering with you 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 will provide regular updates on your child’s progress. If they require continued care and monitoring, we will help transition your child’s care to an adult orthopedic team.

Outlook for children with idiopathic scoliosis

Almost all children with surgically corrected idiopathic scoliosis do well and lead active, healthy lives. With a few exceptions, children can return to sports. Scoliosis surgery does not affect the ability to choose a career with high physical demands, nor does it affect childbearing in adulthood. When clothed, most children with idiopathic scoliosis show no visible signs or symptoms of idiopathic scoliosis five years after surgery.

Why choose CHOP’s scoliosis experts?

CHOP is consistently ranked among the best in the nation for orthopedic care, according to U.S. News & World Report. Our Spine Program is one of the largest multidisciplinary programs in the world dedicated to the diagnosis and treatment of pediatric spine conditions. We have led the development and introduction of new treatments, from innovative bracing and exercise therapy to new surgical approaches.

We provide complete evaluation and treatment to thousands of babies, children and teens with spinal deformities and other conditions affecting the spine. Every spine condition is different, so treatment is determined on a case-by-case basis. We care for children with all types of scoliosis, from mild to the most severe.

We know it’s important to explore all non-surgical options when it comes to treatment for your child’s spinal condition. That’s why we focus on non-invasive treatment options first, whenever possible, including bracing, casting and special physical therapy programs. When surgery is necessary, we utilize cutting-edge navigation and imaging equipment in our operating rooms and follow enhanced safety protocols. And in the most severe cases, where the curvature of the spine causes breathing problems or restricts your child’s lung development, our Wyss/Campbell Center for Thoracic Insufficiency Syndrome is here to help.