Pediatric Scoliosis

The treatment plan for your scoliosis depends on its severity and may slightly vary by doctor. In general, however, treatment is prescribed as:

• Observation. Recommended for curves less than 25º to 30º or people who have stopped growing and have curves that aren't changing or causing problems. Many kids have curves that will never progress past 25ºor 30º and will never need to wear a brace. X-ray evaluations occur every 4 to 6 months so doctors can determine whether bracing is necessary. Observations may continue for years—with doctor visits reduced to every year or every few years—to ensure your scoliosis doesn't progress into adulthood.
• Bracing. Recommended for curves larger than 25º, but smaller than 45º to 50º in someone who is still growing.
• Surgery. Recommended for people with curves usually greater than 45º or 50º and/or who are at high risk of continued worsening even after they are finished growing. Curves that grow very large may cause pain, limit certain body functions and cause difficulty or discomfort in breathing. Surgery is almost always a family decision, one that you and your family or guardians will make based on how you feel.

While yoga, physical therapy, or chiropractic medicine have not been scientifically proven to prevent curve progression, they can help strengthen your core and manage pain.

Your doctor will recommend a brace based on the location and degree of your curve(s), such as:

• Thoracolumbar-Sacral Orthosis (TLSO)—Most effective for mid-back and lower curve, this molded brace is fitted high beneath the arms and close to the skin so it's not obvious under clothes. The less time the brace is worn, the greater risk the patient has for curve progression.
• Night-only Brace—Not commonly prescribed; most effective for moderate, flexible curves.
• Full-torso Brace—Typically prescribed for high curves. A ring around the neck has rests for the chin and the back of the head, and attaches to bars in the front and back of the brace.

To stop progression of your curve(s) and, ultimately, avoid a spinal fusion surgery. A 2013 study tested the effectiveness of adolescent brace wear. About 3/4 of the patients who wore a brace had curves that stayed at less than 50º when they were full grown. More than half (58%) of those who did not wear a brace had curves that progressed to 50º or more (Weinstien SL et al., N Engl J Med 2013; 369: 1512).

Yes! A 2013 research study used temperature sensors in the braces to track brace wear. Patients who wore the brace for less than 6 hours a day had roughly the same success rate as those patients who did not wear the brace at all! Those who wore the brace more than 13 hours a day had a success rate of 90% or higher.

In adolescent idiopathic scoliosis, the primary surgery used today is fusion surgery. In this surgery, metal implants are attached to the spine and then connected to a single rod or 2 rods. This configuration holds your spine correction in place until the vertebrae fuse together into the corrected position. The incision is usually made in your back, but can be made in the front if you have a single thoracic (middle or middle-upper back) or a single lumbar (lower back) curve. The surgery will take several hours to complete. Patients usually stay in the hospital for 3 to 6 days after the surgery. As new, promising surgical procedures are being studied and tested, spinal fusion remains the prevalent and most enduring procedure to date. Your surgeon will discuss all the specifics of your surgical options with you, and can answer all of your questions.

Spinal fusion surgery should stop your curve from growing and will very likely also significantly improve the curvature.

Everyone recovers differently, but here is what typically occurs:

3-6 days post-surgery:Leave hospital10-14 days post-surgery:Discontinue pain medication3-4 weeks post-surgery:Return to school7 days - 6 months post-surgery:Gradually return to activities6 months post-surgery:Resume full participation in all activities