How to Manage Pediatric Scoliosis

An estimated 2 in 50 children have scoliosis, a condition that causes the spine to curve. “The bones in the spine, or vertebrae, actually twist, similar to a corkscrew,” says John Braun, MD, a Mass General Brigham spine and scoliosis surgeon who cares for patients at Massachusetts General Hospital.

This curvature becomes more noticeable during adolescent growth spurts. Still, it can be a surprise to learn that your child has scoliosis. Dr. Braun explains how this condition affects children and what treatments can help.

What causes scoliosis in children?

Adolescent idiopathic scoliosis (AIS) accounts for up to 85% of pediatric scoliosis diagnoses. Although idiopathic means there’s no known cause, Dr. Braun’s research shows that 97% of scoliosis cases in children have a family or genetic cause. “Our findings suggest that gene changes cause most cases of childhood scoliosis,” says Dr. Braun. “But we’re still trying to determine which genes play a role.”

Children with neuromuscular disorders, such as cerebral palsy and muscular dystrophy, are more likely to have scoliosis. Less commonly, a baby is born with congenital scoliosis (a type of birth defect).

How serious is pediatric scoliosis?

The degree or severity of the spine curvature determines the seriousness of the condition and treatment plan. Most spinal curves don’t cause serious problems. But a severe curve can put pressure on your child’s heart and lungs, affecting their ability to breathe. Excess pressure on the spinal cord and nerves can cause pain and affect movements.

What are the signs of scoliosis in children?

A mild spinal curvature may not be noticeable or cause symptoms. Adults with scoliosis may have back pain. That symptom is less common in children. Instead, your child may have:

• One side of their rib cage that sticks out when bending forward (rib hump)
• Posture that leans to one side
• Uneven hips, shoulders, and/or waist
• Shoulder blade that sticks out more than the other

How do doctors diagnose pediatric scoliosis?

Health care providers may check for scoliosis during annual wellness exams or sports physicals. Some schools still offer scoliosis screenings. These tests help diagnose scoliosis:

• Forward bend test: Your child bends forward at the waist to make a spinal curvature or rib hump easier to see.
• Scoliometer: Providers use this tool during a forward bend test to measure the degree of the spinal curvature.
• Imaging tests: Your child may get an x-ray or MRI to determine the degree of the spinal curvature.

How do doctors treat scoliosis in children?

A spinal curvature won’t improve on its own, but not every child with scoliosis needs treatment. Doctors consider how severe the curvature is when deciding on scoliosis treatment.

Watchful monitoring of spinal curvature

If your child has a mild curve that’s less than 25 degrees, they may get x-rays every 4 to 6 months. “We use low-dose x-rays to monitor for spine changes and minimize a child’s lifetime exposure to radiation,” says Dr. Braun. Your child will get x-rays until they’re finished growing.

Back braces for scoliosis

Children with moderate curves between 25 degrees and 40 degrees may wear a back brace to keep the curve from worsening. “A brace slows disease progression, stopping the curve from getting worse,” says Dr. Braun. “It can’t correct the existing curvature or make a child’s spine straighter.”

Your child wears their custom-fitted brace almost every hour of the day, including while sleeping. “They can take it off for physical activities and showering,” says Dr. Braun. Your child needs to wear the brace for several years until they’re finished growing. Getting teens to wear the brace can be a struggle, admits Dr. Braun. “But without the brace, their curve could become so severe that they’ll need surgery.”

Surgeries for pediatric scoliosis

Children with severe spine curvatures of 40 degrees or more need spinal surgery. “Even if a child has stopped growing, the curvature will continue to get worse by one degree every year of adulthood,” says Dr. Braun. “Eventually, they won’t be able to stand upright. They can have serious health problems when the curved spine puts pressure on organs.” Spinal surgery can protect your child’s health now and in the future.

Types of surgeries for pediatric scoliosis

For decades, spinal fusion was the go-to surgery for children with severe scoliosis. But since 1999, Dr. Braun has been helping to pioneer a surgical alternative to fusion called anterior vertebral tethering (AVT).

Spinal fusion

With this procedure, a spine surgeon uses rods, screws, and a bone graft (bone from a donor) to permanently join two or more vertebrae. Fusion straightens the spine and keeps it from curving again.

But fusion also stops spinal growth and affects movements like twisting and bending. A less flexible spine can limit certain activities like dance and gymnastics. Over time, a spinal fusion can cause the vertebrae above and below it to wear down. Back problems can develop in adulthood that require more spinal surgeries. “Fusion is still a good, safe option for certain children,” says Dr. Braun.

Anterior vertebral tethering (AVT)

Also called vertebral body tethering (VBT) or tethering, AVT involves connecting a flexible cord (tether) to an anchor secured to your child’s spine. As your child grows, the cord gently pulls the spine into a straighter position. Tethering helps maintain the spine’s natural growth while allowing for more spinal flexibility and movement than fusion.

Orthopedic surgeons like Dr. Braun perform this minimally invasive surgery using an endoscope (thin tube with a camera) and tiny instruments. Surgery takes place through three small (less than 1 inch) incisions underneath your child’s armpit. “Recovery from tethering is less painful and easier than fusion, which means kids get back to their usual activities faster,” says Dr. Braun.

Tethering is an option for children with spinal curvatures between 40 degrees and 60 degrees. More severe curvatures require spinal fusion. In some cases, Mass General Brigham orthopedic surgeons perform both tethering and fusion in a hybrid procedure.

Scoliosis and your child’s future

With proper treatment, your child can enjoy an active childhood and adulthood. “The condition shouldn’t affect a child’s ability to be engaged in sports, have children in the future, or do whatever else they desire,” says Dr. Braun.