Scoliosis

    What Is Scoliosis?

    Scoliosis measurements drawn by Kit M. Song, MD

    Scoliosis spine curves measured using the Cobb method. Scoliosis is a sideways curve in the spine. On an X-ray, most children’s spines look straight. The spines of children with scoliosis curve to the side, like the shape of the letters S or C. Many children have slight side-to-side curves in their spines. They usually do not need treatment. In children with scoliosis, the bones of the spine (vertebrae) have greater than 10 degrees of tilt.

    Kinds of Scoliosis

    There are different kinds of scoliosis:

    Functional scoliosis

    Functional scoliosis is a curvature due to a problem that does not involve the spine, such as having legs that are different lengths or muscle spasms caused by pain. These can cause a child to lean to the side, creating the appearance of scoliosis. The curvature, however, is flexible and will go away if the problem that causes the child to lean to the side goes away.

    Structural scoliosis

    In structural scoliosis, the spine curvature is not flexible and does not go away with a change in position. There is no evidence that functional scoliosis will lead to structural scoliosis.

    Idiopathic structural scoliosis

    Idiopathic means we do not know the definite cause of the problem. This is the case for 80% of children with structural scoliosis. We do know that children with idiopathic structural scoliosis do not have other health conditions associated with scoliosis.

    Structural scoliosis associated with other conditions

    In about two out of every 10 cases, children with structural scoliosis also have one of these conditions:

    • Born with vertebrae that do not develop normally (congenital scoli)
    • An underlying problem in the brain or spinal cord
      muscular dystrophy (MD)

      A group of inherited disorders of the muscles that can cause them to become very weak.

      , such as a cyst

      muscular dystrophy (MD)

      A group of inherited disorders of the muscles that can cause them to become very weak.

      or a tumor.

    • A problem with nerves or muscles, such as cerebral palsy
      muscular dystrophy (MD)

      A group of inherited disorders of the muscles that can cause them to become very weak.

      or muscular dystrophy (MD)

      muscular dystrophy (MD)

      A group of inherited disorders of the muscles that can cause them to become very weak.

    Scoliosis in Children

    Between one and three of every 100 children have a measurable curve in their spines (more than 10 degrees of tilt on an X-ray) that does not have a known cause (idiopathic scoliosis). But only about two of every 1000 children ever gets a curve that is large enough to need treatment. Equal numbers of boys and girls have the smaller curves that need no treatment. Girls are seven times as likely as boys to have the larger curves in their backbones.

    Scoliosis at Seattle Children’s

    Our team is known nationally for treating all kinds of spinal deformities in children. We have treated thousands of children with scoliosis, ranging from teenagers with idiopathic scoliosis to children with forms of the condition that involve their nerves and muscles. Each year, our spine team evaluates 500 to 600 children with spine problems. At Seattle Children’s, we offer your child the support of an entire medical center. Complex spine cases usually involve bigger, more severe curves that are more difficult to correct and affect the spinal cord and lungs. In caring for children with these more difficult cases, we often work with experts in children’s lungs (pediatric pulmonary specialists) and nervous systems (neurosurgeons). Our surgical spinal cord monitoring team leads the country in developing new techniques for making back surgery safer. We have developed recent advances in spinal cord monitoring and treatment of scoliosis in very young children (infantile scoliosis).

    Symptoms of Scoliosis

    Usually, you can begin to see scoliosis when a child is between 8 and 10 years old. As your child grows and the condition progresses:

    • The bones of the spine may rotate slightly, making it look like your child’s waist or shoulders are uneven.
    • One or both shoulder blades may stick out.
    • The hips may seem elevated, or your child may lean to one side.

    Scoliosis Diagnosis

    ScoliosisCobb method used to measure scoliosis spine curvature. The endplate of the most deviated vertebrae are marked and a right angle line drawn. The angle created by the intersecting lines indicates the degree of curvature.

    To measure scoliosis, we use the Cobb method. The image to the right shows an example of how we take the measurement.

    First, we identify the bones in the spine that are tilted the most. Next, we draw a line along the ends of these bones, which allows us to measure the angle of the tilt.

    When you and your child visit our clinic, doctors examine your child:

    • We ask your child to bend forward so we can check for a bump along the back that is a sign of scoliosis.
    • We take X-rays of your child’s spine to help us find out what type of scoliosis they may have.
    • We find out whether your child might have one of the conditions that sometimes comes along with scoliosis.
    • Sometimes we ask that a child have an MRI (magnetic resonance imaging)
      MRI (magnetic resonance imaging)

      A process that creates high-quality pictures of the inside of the body. An MRI uses a large magnet to create these pictures.

      scan of the spinal cord. This is to make sure that a cyst or spinal tumor is not causing the scoliosis. This is more common for younger children who have large deformities in the bones in their backs.

    Finding out what type of scoliosis your child may have is important because different types of scoliosis progress in different ways and need different treatments.

    We offer the most current treatments for children with scoliosis. When appropriate for your child, this includes investigative treatments. We perform surgeries to correct spinal deformities, and we also offer treatments that do not involve surgery.

    Scoliosis Treatment Options

    Young children whose spinal curves are between 20 degrees and 40 degrees may benefit from wearing a back brace to stop the curve from getting worse as they grow.

    If your child begins treatment with a brace, they may wear it until they finish growing or the curve gets so large that they need surgery.

    With this therapy, fitting the brace correctly is important. We have extensive experience in making braces to fit children of all sizes and ages. Read about braces and our other orthotics and prosthetics services.

    Therapies such as massage, physical therapy, chiropractic manipulations, exercise programs and electric stimulation do not hurt the spine. But they have not been shown to correct scoliosis or prevent the progress of it.

    Surgery for Scoliosis

    Children with spinal curves that are greater than 50 degrees may need surgery. Our surgical team uses a number of operations to correct the curve and stabilize the spine.

    Scoliosis SurgerySpinal instrumentation. Many forms of spinal instrumentation are used in scoliosis surgery. The classic Harrington instrumentation (red arrow) and more modern CD form (yellow arrow) are examples.

    Spinal fusion

    The most common operation for scoliosis is spinal fusion, which straightens your child’s spine by releasing some of the ligaments and joints around the spinal cord and attaching a metal rod to the bones in the back.

    In a spinal fusion operation, the doctor makes a cut (incision) to reach your child’s spine. The doctor reaches the spine either from the back (posterior approach), or from the side (anterior approach).

    The doctor puts hooks or screws in the bones of the spine, removes the joints

    between the bones and attaches the rod to the hooks or screws.The doctor repositions your child’s spine so that it is straighter. Then the doctor tightens the screws or hooks to make sure they are firmly attached to the rod. Finally, the doctor places a bone graft

    along the spine to help the bones of the spine grow together.

    Spinal fusion using thoracoscopy

    It is possible to use a minimally invasive procedure

    called thoracoscopy to perform a spinal fusion. Putting rods in to straighten the spine using this technique is also possible, but this is not done very often. Only a very limited number of children have curves that are in the correct shape and location to use this technique effectively.In this operation, the doctor uses special equipment to view the operation on a monitor like a television. Through small cuts (incisions) in your child’s chest, the doctor inserts tiny tools attached to the end of long rods.

    These tools help the doctor attach a metal rod to the bones of the spine. With this operation, the doctor does not need to make a large cut.

    We usually consider this operation only for children with moderately large curves in the chest portion of their spines. The surgery is best done by medical center staff with extensive experience in thoracoscopic work. At Seattle Children’s, we have performed more than 50 thoracoscopic procedures for spinal deformities.

    Growing spine system

    This operation may help very young children whose spines are still growing and who are not helped by treatment with a back brace.

    The operation is called “growing spine system” because it uses spine-supporting metal rods that can be lengthened as your child grows. As in spinal fusion, the doctor attaches a rod to the bones in your child’s spine. Unlike spinal fusion, the doctor does not remove the joints between the bones and does not fuse the spine.

    With this treatment, your child needs surgery about every six months to lengthen the rod as they grow.

    In addition to more conventional types of growing systems, we are one of seven centers in the United States involved in the development of a new technology called vertical expandable prosthetic titanium rib (VEPTR).

    VEPTR allows us to treat spine conditions in very young children who have fused ribs, congenital scoliosis and severe chest wall deformities.

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