Scoliosis Surgery and Other Treatments for Children
Scoliosis refers to curvature of the spine. Our team has the expertise and experience to treat scoliosis – and we see new patients with scoliosis every single day.
This condition is particularly common among girls, typically around the sixth grade. Most often, scoliosis can be treated with observation or bracing. We use a variety of different types of braces, depending on the child's needs.
What Causes Scoliosis?
In most cases, the cause of scoliosis is unknown. Less common types of scoliosis may be caused by neuromuscular conditions such as cerebral palsy, spinal birth defects, or injuries or infections of the spine.
Signs of Scoliosis in Kids & Adolescents
Signs of idiopathic scoliosis typically begin in the preteen years and is more severe in girls than boys. Parents may notice a fullness on one side of their child's back when bent over or that their child's clothes don't “hang right.”
Early scoliosis signs and symptoms may include:
- One shoulder or shoulder blade (scapula) that is higher than the other
- One shoulder blade more prominent than the other
- A curve in the spine or midline of the back
- The head is not centered with the rest of the body
- An increased space between one arm and the body (uneven waistline)
- Uneven hips
- On forward bend, a “rib hump” or one area of the back is higher than the other side
Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. A child experiencing these types of symptoms requires immediate medical evaluation by a physician.
Pediatric Scoliosis Screening Recommendations
Although only 5 percent of those with scoliosis will require treatment, scoliosis screening is important in order to detect it early and begin treatment if necessary.
X-rays are the primary diagnostic tool for scoliosis. By looking at your child's back, you might be able to see a curve. But by taking X-rays, UH pediatric spine specialists can look at the spinal column clearly and measure the curve in degrees.
X-rays of your child’s spine are taken from the back and sometimes from the side. As an alternative to a conventional X-rays, your doctor may order an EOS X-ray, which is a technique that captures information-rich images using a significantly lower amount of radiation than conventional X-rays. Occasionally, magnetic resonance imaging (MRI) may also be recommended.
In addition to X-rays, the doctor will take a full medical history, conduct a thorough physical examination and perform neurological tests to check for:
- Muscle weakness
- Abnormal reflexes
Although there is research being done to look for a hereditary link, a genetic test for idiopathic scoliosis does not exist.
It is important to know that not all children diagnosed with scoliosis will need treatment. For mild cases, UH Rainbow pediatric spine specialists can often prevent the condition from worsening or causing other complications such as a rotating spine, uneven hips and breathing challenges.
In these situations, when mild scoliosis is present but no active treatment is recommended, your child should be examined by a UH spine specialist every four to six months, especially during the years of rapid growth, to make sure the curve is not getting worse.
What Will Happen if Scoliosis Is Not Treated
For cases of moderate to severe or progressive scoliosis, it is important to treat for two main reasons:
- Health problems – While health problems may not show up until children are older, changes in heart and lung function can occur if their curve is allowed to become severe. In addition, although children may not have pain now, abnormal posture could lead to limited activity, discomfort and arthritis as they get older.
- Appearance – Scoliosis signs and symptoms affect the shape of your child's body. If the curve increases too much, the physical changes may be apparent even when he or she is clothed, affecting self-esteem and body image.
Early onset scoliosis (EOS) is a curvature of the spine that is diagnosed in patients under the age of 10.
Types of Scoliosis
There are several types and causes of early-onset scoliosis:
- Congenital: Caused by misshaped bones, or vertebra, in the spine
- Neuromuscular problems, such as cerebral palsy, myelodysplasia or muscular dystrophy, in which muscles cannot hold the spine straight
- Genetic syndromes that affect more than one part of the body
- Idiopathic: In which there is no clear cause of the scoliosis
Diagnosing and Treating EOS
Doctors use an X-ray of your child’s spine to confirm an early-onset scoliosis diagnosis. If EOS is diagnosed, your child’s doctor may recommend additional testing. Often magnetic resonance imaging (MRI) and/or other tests may be ordered, depending on the situation. As your child grows, radiographs will be used to follow the curve over time to see if it is getting bigger with growth.
There is a wide range of treatments for EOS, and each patient’s treatment is unique to their specific condition. Some patients may only need to be monitored while growing. Patients with small to moderate size curves may wear a brace or be fitted with a series of casts. Braces and casts are normally used to prevent the curve from getting worse and are very effective in some patients. Patients with more severe curves may need surgery to correct their curve. Pediatric orthopedic spine specialists at UH Rainbow Babies & Children’s have expertise in diagnosing and treating a variety of conditions that cause EOS. They are up to date with all the current nonoperative and operative techniques, as they are a participating center in the international early onset scoliosis research section of the Pediatric Spine Study Group.
Children and families who are undergoing treatment for EOS have the benefit of a team approach, which includes their surgeon and our pediatric orthopedic nurse team. Since EOS is variable and treatment can be challenging, our patients get excellent support from the nursing team who assist with teaching, casting, brace management and more.
Treatment for Idiopathic Scoliosis
UH Rainbow Babies & Children’s Hospital offers a variety of advanced surgical and non-surgical options to treat scoliosis in children and adolescents. Depending on the type of scoliosis, the progression of the spinal curvature, and the age of the patient, our team can evaluate each individual child and develop a treatment plan specific to that child’s needs.
Recommended pediatric scoliosis treatments may include:
A brace is used to prevent moderate curves (25-40 degrees) from getting worse until your child is finished growing. It is very effective but not always successful. Braces will not cure or correct the curve.
Some braces are worn only at night, some are worn more hours during the day. The type of brace and the amount of time spent in the brace will depend on what your doctor feels is best for your child. Braces are worn until the child is fully grown. They are worn under the clothes and participation in activities is not restricted.
- Growing Rods
Growing rods are effective for very young children with severe spinal deformity. This technique allows the spine and lungs to continue growing as the child grows. Unlike traditional casting and halo traction, growing rods help young patients integrate easily into school and their social environment.
The procedure involves the insertion of one or two rods under the back muscles and attaching them above and below the spine’s curve. They are adjusted about every nine months to enable growth, although newer systems grow with the child and do not require frequent returns to the operating room. Our highly-trained orthopedic surgery team offers two of these new and unique surgical procedures which include:
- The Shilla™ Growth Guidance System: This system uses a special non-locking screw at the top and bottom of the growing rod, which allows the rod to slide through the screw heads as the child’s spine grows, while still providing correction of the spinal deformity.
- MAGEC™ Growing Rod: This uses a magnetic device inside the growing rod, which can be expanded painlessly and noninvasively via an external remote control.
The Shilla and MAGEC devices were approved by the Food and Drug Administration in 2014; both are part of treatment offered by the pediatric scoliosis experts at UH Rainbow.
- Scoliosis Surgery
If the scoliosis curve is greater than 45 or 50 degrees spinal fusion surgery may be a viable treatment option. In spinal fusion, screws, rods and bone grafts are used to fuse the vertebrae together.
Our surgeons also offer spinal osteotomy procedures as part of a spinal fusion to increase the spine’s flexibility. UH Rainbow is one of a limited number of specialized centers in Ohio that performs this procedure regularly in children.
- Firefly® Technology
Firefly® Technology uses specialized software to convert CT images into an exact, three-dimensional computer image of the patient’s spine. 3-D printing technology then converts the image into a model of the spine that surgeons can hold and study from all angles, enabling them to plan and practice their surgical approach.
Spine surgery often requires placing screws to correct and maintain the vertebrae’s position. As part of the preoperative planning, Firefly® also provides 3-D printed guides so that during surgery, the surgeon can insert these screws through preselected pathways. Knowing exactly where to insert the screws eliminates the need for image-guided navigation and greatly reduces radiation exposure to the patient. Firefly® also decreases the risk of spinal cord, nerve and tissue damage. The pediatric spine specialists at UH Rainbow were the first in Northeast Ohio to use Firefly® Technology.
Spinal surgeons at UH Rainbow have access to the latest technology in preoperative planning, intraoperative templates and computer-assisted navigation for spine procedures. Using this technology allows for accurate placement of implants, and is particularly useful when the anatomy of the spine is abnormal, such as cases of severe curvature or curvatures caused by congenital differences in the spine. Intraoperative 3-D images can also be used to confirm accurate implant placement prior to leaving the OR.
- Vertebral Body Tethering
- The Tether™ Vertebral Body Tethering System is a non-fusion spinal device that treats idiopathic scoliosis in young patients whose bones have not fully matured. With this technology, an anchor and bone screw are placed into the patient's spine on the side of the spinal curvature. The cord is secured to the bone screws using set screws. During surgery, the surgeon will apply tension to the cord to partially straighten the patient's spine. After surgery, the cord continues to straighten the spine while the patient grows. Use of this technology can help prevent curve progression in the hopes of avoiding spinal fusion surgery later.
- ApiFix Procedure
UH Rainbow is one of 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 this innovative procedure, surgeons use screws and anchors to attach a flexible rod to the spine. This rod allow for movement and flexibility as the curve is corrected and the patient grows. The ApiFix surgery takes about 90 minutes to two hours and patients can return home in one to two days. Patients can typically resume activities in four to six weeks, compared to four to six months with traditional spinal fusion.