Treatment for Kyphosis, Severe Scoliosis and Other Spinal Deformities

Frequently Asked Questions

How is scoliosis diagnosed?

Scoliosis can be screened for by a school nurse or your child’s pediatrician. During the screening, they will examine your child from different angles, observing posture and looking for asymmetry in the shoulders or hips. If scoliosis is suspected, your child will be referred to a pediatric orthopedic expert for a more in-depth physical exam. During this exam, the scoliosis expert will ask questions about your child’s medical history and examine the back, shoulders and pelvis to see if they are level. Your child will be asked to lean forward so that the doctor can observe and measure the extent of the spine’s curve.

What tests are needed?

If a spinal curve is observed, your child’s doctor will order X-rays of the spine. Additional tests such as magnetic resonance imaging (MRI) may also be needed. Follow-up X-rays may be ordered to see if the curve gets bigger over time.

Should I worry about radiation exposure?

If your child is diagnosed with scoliosis, they may have to receive many X-rays throughout the course of their treatment. Naturally, you might worry about radiation exposure. However, UH Rainbow is proud to provide EOS imaging technology for our pediatric patients, which offers a significantly lower dose of radiation than traditional imaging methods. This technology can take full-body 2-D/3-D images, making it ideal for adults and children with orthopedic conditions such as scoliosis. EOS imaging is capable of taking a full body image of a child in about 15 seconds. UH is the only hospital in Ohio to have the most advanced version of EOS technology – called EOSedge – available for patients.

How is scoliosis treated?

There are many options for treating scoliosis, ranging from simple observation to surgery. The type of treatment recommended will depend on several factors, including the child’s age, the size, shape and location of the curve, and how fast it is progressing.

For curves less than 25 degrees, observation is usually recommended. You will follow up with your child’s orthopedic surgeon every 4 to 6 months to see if the curve is growing or staying the same.

Bracing is often recommended for still-growing children with a curve over 20-25 degrees. A brace will help prevent the curve from getting bigger. Sometimes braces are worn only at night; sometimes they are also worn for longer periods of time during the day. This will vary on a case-by-case basis. Wearing a brace can be important in helping to avoid surgery for scoliosis.

Surgery is reserved for large curves that are over 45 – 50 degrees. In these cases, a brace will not work and surgery is the best option. Surgical options based on age include growing rods (and MAGEC™ rods), vertebral body tethering, Apifix ™ and spinal fusion. The team can also utilize Pulse advanced technology that makes pediatric spinal surgery safer, faster and smarter.

I had scoliosis. Does that mean my child will, too?

There is strong evidence to suggest that scoliosis runs in families. Nearly a third of children with adolescent idiopathic scoliosis have a family history of it. This does not mean that your child will definitely develop scoliosis if you had it, however. Research has shown that about 29 percent of daughters and 9 percent of sons of people who had scoliosis will develop the condition.

What if my child’s curve worsens – what are the options for surgery?

There are a few different options for surgical intervention in scoliosis patients. The traditional operation for scoliosis is spinal fusion surgery, which uses screws, rods and bone grafts to fuse vertebrae together. However, there are other methods that are proving to be successful in younger scoliosis patients who are still growing. This includes the use of growing rods and MAGEC ™ rods for younger children with spinal deformity and vertebral body tethering , which can help prevent curve progression and potentially avoid spinal fusion surgery down the road. We also offer ApiFix, an innovative alternative to spinal fusion that uses a flexible rod to help the child retain movement as they grow. The team can also utilize Pulse advanced technology that makes pediatric spinal surgery safer, faster and smarter.

The type of surgery recommended will depend on several factors, including the type of scoliosis, the child’s age and severity of the curve. Your child’s doctor will discuss the options and their benefits and risk with your family before developing a treatment plan.

Are there newer more advanced procedures for scoliosis and spinal deformities?

UH Rainbow pediatric orthopedic surgeons offer a range of advanced surgical options to treat scoliosis and other spinal deformities. Our team uses growing rod technology – including the Shilla™ and MAGEC™ growing rod systems – to treat younger children with severe spinal deformities. Growing rods allows the spine and lungs to continue to grow with the child.

Another surgical technique uses the Tether™ Vertebral Body Tethering System in younger patients with idiopathic scoliosis. This non-fusion device uses a strong, flexible cord – attached to the bone with anchors and screws – to gradually straighten the spine as the child grows. Our team also utilizes Firefly® technology, which uses specialized software to create a 3-D printed model of the child’s spine to guide surgeons in the precise placement of screws and reduce surgery time.

UH Rainbow is also one of about 20 sites in the U.S. to offer ApiFix, a less-invasive alternative to spinal fusion that preserves motion and function in children with adolescent idiopathic scoliosis. With ApiFix, surgeons use screws and anchors to attach a rod to the spine that allows movement as the curve is corrected and the patient grows. Patients who undergo ApiFix return home in one to two days and resume normal activities in four to six weeks, compared to four to six months with traditional spinal fusion.

The vertical expandable prosthetic titanium rib (VEPTR) is used to treat children with thoracic insufficiency syndrome, which causes severe deformities of the chest, spine and ribs. The device is a metal rod that surgeons attach to the child’s ribs, spine or pelvis. It helps straighten the spine and separate the ribs and can expand or contract as the patient grows.

Additionally, UH Rainbow recently became the first facility in the world to perform pediatric spine surgery using the Pulse surgery platform. This technology is designed to increase safety, efficiency and reproducibility of surgical outcomes in spine surgery. The platform integrates radiation reduction, imaging enhancement, rod bending, navigation, intraoperative neuromonitoring, and spinal alignment tools.

Pulse helps surgeons address some of the most common clinical challenges in spine surgery, such as radiation exposure and nerve and spinal cord injury. It can reduce time in the OR, time under anesthesia and length of hospital stay for patients and can lower intraoperative risks.

What should we expect if my child needs surgery

Surgery is recommended if your child’s curve is greater than 45 to 50 degrees. At this degree, the curve is likely to get worse, not only affecting the child cosmetically, but also affecting lung function. Surgery may or may not be recommended for children with a curve between 40 and 50 degrees. This will depend on many factors that your child’s surgeon will discuss with you.

With the latest innovations in spinal fusion and other scoliosis procedures, our pediatric orthopedic surgeons can significantly straighten a child’s curve in most cases. The degree to which the curve is straightened will depend on the flexibility of the curve. Most patients will be able to recover from surgery with a curve less than 25 degrees.

Your child will be in some pain immediately following surgery, which will be controlled with pain medications, delivered either intravenously or with oral medications. This pain will likely resolve over the period of a few weeks or months.

Full recovery time varies depending on the patient and the surgery performed. With spinal fusion, your child will need to limit heavy lifting and bending for about six weeks and will be able to resume sports and other activities in four to six months. Some of the newer surgeries, such as ApiFix, require an even shorter recovery time – four to six weeks before resuming sports and activities.

With spinal fusion, the fused portion of the back will be permanently stiff. However, most patients have enough range of motion in the unfused areas to participate in sports and other activities, though it may take about a year to fully adapt. Patients who undergo surgeries that do not involve fusion will have even more flexibility after they recover.