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Scoliosis is a three-dimensional abnormality of the spine that is best known for a noticeable sideways curvature. Accompanying this sideways curve is a rotational abnormality of the ribs and a loss of the normal backward curvature.
According to board-certified pediatric orthopedic surgeon Cheryl R. Lawing, MD, “Scoliosis affects 2 – 3% of the population, though this risk goes up to around 11% if you have a first-degree relative who has it. Only around 0.1% of the population needs surgery for scoliosis.”
Dr. Lawing assures us that if your child is diagnosed with scoliosis, you can have peace of mind that the odds are overall low that they’ll need surgery.
The majority of scoliosis (80 – 85%) develops during the growth spurt during adolescence. Middle schools in Florida screen for scoliosis and it’s also a part of your child’s routine wellness visits with their pediatrician.
“During this growth spurt,” says Dr. Lawing, “scoliosis can progress quite rapidly. However, 15 – 20% of children with scoliosis have an early onset, before their teenage years. This can develop as early as infancy, and due to the remarkably fast growth rate of babies, scoliosis in babies can progress rapidly.” Dr. Lawing encourages that every child, including babies, should be screened for scoliosis at their well-child visits.
What is the Treatment for Scoliosis?
Dr. Lawing explains, “Treatment for scoliosis depends on the age and maturity of your child and the size of the curve. Most small curves that are less than 20 degrees won’t progress and can be observed. For the curves that do progress to the low to mid-20s, we use braces (thoracic lumbar sacral orthoses or TLSO) to keep it from getting worse. Braces cannot correct scoliosis, but can be highly effective in preventing progression, or worsening, of your child’s curve. Because braces do not correct scoliosis, but only keep it from getting worse, close monitoring is necessary for borderline curves to allow for early initiation of the brace once the curve needs treatment.”
Braces work by helping to more evenly distribute the forces across the growth plates of your child’s spine. Dr. Lawing says, “Once your child is done growing, there is no further role for bracing. There are two main types of braces. A full-time brace is worn with a goal of 18 – 23 hours a day until your child is done growing. “
Nighttime bending braces are worn only at night and work by bending your child’s spine into a more exaggerated corrected position. Medical studies suggest that the full-time braces are more powerful and we typically use them in higher-risk curves.
Once a curve reaches a certain size, 50 degrees for thoracic curves, surgery is recommended to keep it from getting worse throughout your child’s life. Dr. Lawing explains, “Surgery takes the form of posterior spinal fusion, which uses rods and screws to pull the spine as straight as possible and help it heal in this better position. While your child won’t be able to do sports for about six months, most children are able to resume their normal activities starting at six months after surgery.”
Although this is a big surgery, we have a number of tools we use to make it very safe. Children typically spend three days in the hospital after the surgery.
“For babies with scoliosis,” continues Dr. Lawing, “the curve can progress so rapidly that there is potential for their heart and lungs to be impacted. Mehta casting is a non-invasive tool that can be used to stop progression. In around 50% of children, the scoliosis is cured. This involves a series of casts that are placed under general anesthesia, but doesn’t involve surgery or incisions on your child’s back.”
The casting works by harnessing the remarkably rapid growth of the first five years of life and is more effective the earlier it’s started.
We’re Here to Help Your Child Heal
If you suspect your child may have scoliosis, talk to your pediatrician. To learn more about scoliosis and its various treatments, visit AdventHealthforChildren.com/Orthopedics.