Deformity

Scoliosis

Signs and Symptoms
Diagnosis
Treatment

Treatment

Most spine curves in children with scoliosis will remain small and need only to be watched by an orthopedist for any sign of progression. If a curve does progress, an orthopedic brace can be used to prevent it from getting worse. Children undergoing treatment with orthopedic braces can continue to participate in a full range of physical and social activities.

If the curve of the spine is severe when first seen, or if treatment with a brace does not control the curve, surgery may be necessary. Adult scoliosis may be the result of the progression of a condition that actually began in childhood and wasn't diagnosed or treated while the person was still growing. Surgery for scoliosis is an effective and reliable technique for stopping progression of deformity, and for reducing deformity within the spinal column.

There is no clear evidence that untreated scoliosis, or scoliosis treated with bracing or spinal fusion, will increase the risk of back pain or arthritis in the long term. The younger a child, or the more she or he has to grow, the greater the risk of scoliosis progressing. After puberty, curves under 50 degrees are not likely to get worse. For this reason, the ultimate goal of scoliosis management is to keep curves under 50 degrees until the child has matured. Children with curves under 50 degrees typically grow up into adults with no significant problems related to scoliosis.

Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. The following are general guidelines for treatment.

Less Than 10 Degrees

This is not scoliosis. Scoliosis is defined as spinal curvature greater than 10 degrees. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and for height.

10 Degrees to 30 Degrees

In this range, scoliosis is observed to see if it progresses.

30 Degrees to 50 Degrees

In this range, bracing is the standard of care in the United States. The scoliosis brace is known as a TLSO, which stands for thoraco-lumbar spinal orthotic. The idea behind bracing is to stop or slow progression of the curve so that it stays under 50 degrees. An X-ray of a brace shows that the brace can straighten the spine, but the spine will return to its original curvature when the brace is removed. The two principal types used are the Milwaukee brace, developed by Dr. Walter Blount of Milwaukee and the Boston brace, developed by Dr. John Hall of Boston. Brace treatment successfully stops curve progression in about 80 percent of children.

More Than 50 Degrees

Beyond 50 degrees, the spine loses its ability to compensate and progression becomes inevitable even after the child is mature. The only way to stop progression at this stage is a surgery called spinal fusion. Think of the vertebrae as beads on a string. The spine bends between the vertebrae as a string bends between the beads, causing the beads to move. The way to stop the beads from moving is to stick them together. Spinal fusion surgery joins the vertebrae.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007