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Scoliosis

Your spine, or backbone, helps hold your body upright. Without it, you couldn't walk, run, or play sports.

If you look at yourself sideways in the mirror or look at a friend from the side, you'll notice that the back isn't flat like a piece of board. Instead, it curves in and out between your neck and lower back. Despite that gentle curve from the side, a healthy spine appears to run straight down the middle of the back. The trouble for someone with scoliosis is that the spine curves from side to side.

What Is Scoliosis?

The word scoliosis (say: sko-lee-OH-sis) comes from a Greek word meaning crooked. If you have scoliosis, you're not alone. About 3 out of every 100 people have some form of scoliosis, though for many people it's not much of a problem. For a small number of people, the curve gets worse as they grow and they may need a brace or an operation to correct it.

illustration

Someone with scoliosis may have a back that curves like an "S" or a "C." It may or may not be noticeable to others. While small curves generally do not cause problems, larger curves can cause discomfort. The X-ray image to the right shows what scoliosis looks like.

No one knows what causes the most common type of scoliosis called idiopathic (say: ih-dee-uh-PA-thik) scoliosis. (Idiopathic is a fancy word for unknown cause.) Doctors do know that scoliosis can run in families. So if a parent, sister, or brother had scoliosis, you might have it, too.

Most types of scoliosis are more common in girls than boys, and girls with scoliosis are more likely to need treatment.

How Do Kids Find Out if They Have Scoliosis?

Sometimes scoliosis will be easily noticeable. A curved spine can cause someone's body to tilt to the left or right. Many kids with scoliosis have one shoulder blade that's higher than the other or an uneven waist with a tendency to lean to one side. These problems may be noticed when a kid is trying on new clothes. If one pant leg is shorter than the other, a kid might have scoliosis. It's also possible that the kid does not have scoliosis, but one leg may be slightly shorter than the other or the ribs may be uneven.

You might get examined for scoliosis at school or during a doctor visit. In the United States, about half of the states require public schools to test for scoliosis. It's an easy test called the forward-bending test, and it doesn't hurt at all. It involves bending over, with straight knees, and reaching your fingertips toward your feet or the floor. Then, a doctor or nurse will look at your back to see if your spine curves or if your ribs are uneven.

What if I Have It?

If a doctor says you have scoliosis, then the doctor and your parent can talk about whether treatment is necessary, and then talk to you about what happens next. If the doctor wants to get a better look, he or she may order X-rays of your spine. Sometimes the doctor will decide that the curve isn't serious enough to need treatment.

xray_illustration

If you do need treatment, you'll go to a special doctor called an orthopedist (say: or-tho-PEE-dist), or orthopedic surgeon, who knows a lot about bones and how to treat scoliosis. The orthopedist will probably start by figuring out how severe your spine's curve is. To do this, an orthopedist looks at X-rays and measures the spine's curve in degrees, like you measure angles in math class.

Someone who has a mild curve might just need regular checkups to make sure the curve isn't getting worse. Someone with a more severe curve may need to wear a brace or have an operation.

Treating Scoliosis With Braces

A brace will not permanently correct curves that are already there. A brace for scoliosis is meant to hold the spine in place so the curve doesn't get any worse. Some braces are made to be worn only at night and others are designed to be worn both day and night.

If you need a brace, your doctor can discuss which type would be best for you. Braces are meant to be used while the spine is still growing, especially when it grows very fast during the "adolescent growth spurt." Therefore, a kid with scoliosis will spend less time in the brace as he or she gets older and gets closer to adult size. After the spine finishes growing, braces are no longer necessary or effective.

Doctors try to make better braces for kids with scoliosis, so braces now are lighter, more comfortable, and easier to wear than they used to be. There are many different types of braces. Kids with scoliosis often wear a brace called a thoracolumbosacral orthosis (say: tho-ra-ko-lum-bo-SAY-krul or-THOH-sus), or TLSO for short. This kind of brace comes up under the arms and is more comfortable than the bigger braces.

Braces are usually named after the cities where they were invented and have names like the Boston brace, the Wilmington brace, the Providence brace, and the Charleston brace.

Treating Scoliosis With Surgery

Braces often do the job, but some kids who have severe scoliosis eventually need an operation. Someone who gets this operation will be given anesthesia, a kind of medicine that puts a person to sleep and prevents pain during the operation. During the operation, the orthopedic surgeon fuses the bones in the spine together so that they can no longer continue to curve. The surgeon also uses metal rods and screws to correct the curve and hold everything in line until the bones heal. The metal parts are placed deep under the spine muscles, and in most cases can't be felt and do not hurt. They are meant to be left in the back permanently.

The operation takes several hours, depending on how big the curve is and how many bones need to be fused. Normally, a kid who has this operation will be able to get out of bed the next day and start to walk, doesn't need to wear a cast or brace, and can usually go home in less than a week. The kid can usually go back to school about a month after surgery, then return to some activities in 3 or 4 months, and most normal activities after 6 to 12 months. But keep in mind that each patient's surgery and recovery might be different, depending on the type of surgery and the patient's age.

A metal rod in a kid's back? It may sound strange, but that rod does an important job while the bones are growing together — it corrects the curve and holds the spine in place during healing. The kid can still move to pet a dog, swim laps, or shoot hoops. After the bones fuse, the metal rod isn't needed anymore. But it's not hurting anything, so it isn't removed. To remove it would mean getting another operation. Before they used metal rods, a kid would have to wear a body cast for up to a year to keep the spine in place during the recovery period. No fun at all!

Over the years, the treatments have improved, so more and more kids with scoliosis live normal lives. Doctors don't know of any activities, including sports, that can make scoliosis worse. But kids who need surgery for scoliosis should talk to their doctor about how to participate safely.

Scoliosis may throw you a curve, but with the right care, a kid can grow up healthy and feeling fine.

Reviewed by: Suken A. Shah, MD
Date reviewed: January 2013
Originally reviewed by: Kevin Neal, MD

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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