What is scoliosis?

A normal spine—which is the line of bones going down your back—is usually straight or slightly curved. In scoliosis, the spine curves from side to side, often in an S or C shape. It may also be twisted. Scoliosis can affect adults, but it usually is found in children between the ages of 10 and 16. Scoliosis can limit your child's growth. In very bad cases, your child's lungs may not be able to hold enough air. That can cause the heart to work harder to pump blood.

Young people who have scoliosis usually do not have symptoms, but some may have back pain.

If your child has mild scoliosis, they may need only to see a doctor every several months to make sure the curve is not getting worse. A child who has moderate scoliosis may need a brace. A brace usually stops the curve from getting worse, but it is not able to correct or straighten the spine. Scoliosis that is very bad may need surgery. Scoliosis and its treatment can be hard on a child. Your child may be embarrassed by wearing a brace. Think about taking your child to a scoliosis clinic, where other children are being treated. It may help your child cope with the condition.

Most cases of scoliosis are mild. They involve small curves in the spine that don't get worse. Usually a doctor examines the child every 4 to 6 months to watch for any changes.

In moderate or severe cases of scoliosis, the curves keep getting worse. During periods of growth, such as during the teenage growth spurt, the curves may get worse. Mild to moderate curves often stop progressing when the skeleton stops growing. Larger curves may get worse throughout adulthood unless they are treated.

As scoliosis gets worse, the bones of the spine move toward the inside of the curve. If it happens in the upper part of the spine, the ribs may crowd together on one side and spread apart on the other side. The curve may force the spinal bones closer together. The spinal bones on the outer edge of the curve may also get thick.

In children and teens, scoliosis typically doesn't cause symptoms and isn't obvious until the curve of the spine becomes moderate or severe. It may first become noticeable to a parent who sees that the child's clothes don't fit right or that hems hang unevenly. The child's spine may look crooked, or the ribs may stick out.

In a child who has scoliosis:

• One shoulder may look higher than the other.
• One hip may look higher than the other.
• The child's head isn't centered over their body.
• One shoulder blade may stick out more than the other.
• The ribs are higher on one side when the child bends forward from the waist.
• The waistline may be flat on one side.

Mild cases of scoliosis usually don't need treatment. Physical therapy may be an option. If the curve gets worse, your child may need to wear a brace. In severe cases, your child may need to have surgery.

Scoliosis testing usually starts with questions about the child's past health, plus a physical exam. The exam includes a simple test to see if the child's back or ribs are even. The child bends forward at the waist, arms hanging loosely and palms touching. If one side is higher than the other, an X-ray of the spine may be done. A scoliometer can be used to measure and estimate the rotation of the spinal curve.

Skeletal age is also a helpful measure to find out the risk that the curve will get worse.

If someone in your family has scoliosis, your children should be checked regularly.

Neurological testing may be done on children who have scoliosis. These tests look for certain disorders that are often linked with scoliosis, such as cerebral palsy or muscular dystrophy.

• Keep follow-up visits with your child's doctor.
• If your child has a brace, follow instructions for wearing it.
• Offer your child lots of hugs and emotional support. A child, especially a teen, may feel bad about wearing a brace. If your child seems very sad or depressed for a long time, have your child talk to a counselor.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
  • If your child is not taking a prescription pain medicine, ask your doctor if your child can take an over-the-counter medicine.
• Do not give your child two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Ask your doctor about what type of daily activity is safe for your child.

Surgery may be used to treat severe scoliosis. It usually involves stabilizing the spine and keeping the curve from getting worse by permanently joining the vertebrae together (called spinal fusion).

Other techniques are sometimes used. One technique is called instrumentation without fusion. Devices such as metal rods are attached to the spine. They can stabilize a spinal curve without fusing the spine together.

Surgery may be an option if:

• Your child has a moderate to severe curve, and the curve is getting worse.
• Your child has pain or trouble doing daily activities.

Experts have different opinions about the timing of surgery to treat scoliosis in young children. Spinal fusion stops the growth of the fused part of the spine. So some experts believe that surgery should be delayed until the child is older. But even after surgery, the rest of the spine will grow normally in children who are still growing.

In most cases, the cause of scoliosis is not known. Scoliosis usually starts in the preteen years. In some cases, scoliosis is severe enough to need treatment. A curve in the spine may get worse as your child grows, so it is important to find any problem early.