| Though it can occur in a child of any age, most cases
of Idiopathic Scoliosis begin between the ages of 10 and 15 years
during a growth spurt. In this age group it called Adolescent Idiopathic
Scoliosis (AIS) or just Adolescent Scoliosis. This condition can occur
in both boys and girls but girls are several times more likely than
boys to develop severe curvatures.
Though the cause of Idiopathic Scoliosis remains unknown, it is
interesting to note that the majority (90%)of curves of the upper
spine are on the right side, while the majority (70%)of curves of
the lower spine are on the left side. Curves that affect both the
upper and lower spine are called double major curves – S shaped
curves. Single curves are C shaped.
In some cases a curve in the lower spine may be compensatory –
the body’s way of balancing the curve in the upper spine –
rather than structural. A structural curve of the upper spine with
a compensatory curve of the lower spine is not considered a double
The upper back (thoracic spine) or area between the upper and lower
back are affected more often than the lower back (lumbar spine).
How common is Adolescent Idiopathic Scoliosis?
Although about two to three out of every hundred adolescents have
scoliosis (a curve over ten degrees on x-ray), only two to three
out of every thousand curvatures are severe enough to need treatment.
Treatment consists of wearing a back brace in the majority and surgery
in a minority of these cases.
*About ten percent of people have a slight lateral curvature of
the spine, but not enough to cause a problem or to be considered
Will Adolescent Scoliosis keep progressing?
When growth is complete, curves under 30 degrees usually don’t
get any worse. Bracing for curves that reach 30 degrees to prevent
them from getting worse during the growing years is essential. Bracing
is usually ineffective for curves over 45 degrees. Curves over 45
- 50 degrees almost always keep progressing and usually require
surgery. Spinal fusion surgery halts the progression of the curve
and greatly reduces existing deformity. Spinal fusion involves fusing
two or more vertebrae of the spine together by surgery.
The Emotional Consequences of Scoliosis
Scoliosis has psychological consequences as well as physical consequence.
Self-esteem can be negatively impacted, especially in the formative
adolescent years. Counseling may help a child deal with emotional
issues arising out of having this disorder.
Scoliosis can be so mild that an untrained eye cannot see the curve,
or it can be severe enough to cause deformity
A mild curvature often goes unnoticed. A scoliosis curvature becomes
more visible when the person is bending over. Each side of the back
may appear to be a different height when bending over. Besides a
curve to the spine, Scoliosis can cause one hip or shoulder to be
higher than the other. One shoulder blade may protrude more than
the other. The rib cage may be uneven. The head may not be centered.
One may lean to one side, with one arm hanging lower than the other.
Monitoring Mild Curves (up to 20 degrees)
Mild curves must be Monitored but do not require treatment. A mild
curvature (under 20 degrees) does not usually produce back pain
or cause any problems. Fortunately, most adolescents with scoliosis
fall into this category.
Though mild Adolescent Scoliosis does not require treatment, a
mild curvature may progress quickly in a growing child and must
be monitored by a physician. The progression of scoliosis is unpredictable.
The more growing left, the more likely a curve is to worsen. Double
curves are more likely to progress than single curves. Regular checkups
Back Braces for Moderate Curves (25 – 40 degrees)
Orthopedic surgeons often recommend fitting a young patient with
a back brace when a curvature reaches about 25 degrees to 30 degrees.
Whether or not a back brace is recommended not only depends on how
severe the curve is but how much growing a child has left and the
rate of progression. An orthopedic back brace (orthosis) is usually
worn for a couple of years during the main growth spurt until growth
is completed. A curve under 30 degrees upon completion of growth
is unlikely to get worse.
In growing children, orthopedic braces usually prevent the curve
from getting worse but do not correct the curve that is already
present; therefore, it is important catch scoliosis early. Wearing
a brace will temporarily correct an existing curve but when the
brace is taken off, the existing curve will return.
Some braces only have to be worn at night, some 16 hours per day,
some all the time. Braces can be taken off for activities requiring
bending and twisting such as exercising and sports.
Does Exercise Help?
do not prevent the abnormal curvature of the spine from progressing.
However, exercise is still important. Though Idiopathic scoliosis
does not usually cause back pain, an
abnormal curve of the spine places extra stress on the back muscles.
If back pain develops, doing back
exercises to increase strength and flexibility may help. Consult
your physician before starting an exercise program.
Surgery for Severe Curves (over 45 degrees)
Rarely, the curve still progresses despite the use of bracing.
Spinal curves over 45 to 50 degrees almost always progress and an
orthopedic surgeon will usually recommend surgery in these cases.
Fusing the section of vertebrae where the spine curves stops it
from progressing and significantly reduces existing deformities.
Spinal Fusion Surgery
A section of vertebrae are fused together (forming a single bone).
Steel rods may be implanted, one on each side of a segment of vertebrae,
and attached to vertebrae (by hooks or other means). Bone grafts
(usually small pieces of bone, usually taken from hip) are then
placed between and alongside the vertebrae and slowly fuse to the
vertebrae as a part of the healing process. The fused vertebrae
will hold this section of the spine straight. The rods hold the
spine in position until the fusion is complete (3 months to a year).
The rods are not needed once the fusion is complete but are usually
left in place to avoid more surgery.
Spinal fusion surgery totally stops the curve from progressing
any further. The existing curve is reduced considerably but it usually
isn’t completely eliminated. The results vary but there is
generally significant improvement in appearance
Spinal fusion limits overall range of motion by totally eliminating
any range of motion between the fused vertebrae- the extent of the
limitation of movement is dependent upon the number of vertebrae
involved in the fusion. This is preferable to the deformity of severe
scoliosis, especially if the lungs and heart are being compressed
Is Spinal Fusion Surgery Done Before Growth is Complete?
In growing children or adolescents, the part of the spine that
has been fused can no longer grow, however the rest of the spine
will continue to grow. Many people end up a couple of inches taller
after the surgery anyway, as the curve in their spine is reduced
significantly. Surgery is sometimes done before growth is complete,
depending on the severity of the curve.
An orthopedic surgeon’s recommendation to perform surgery
now or wait until later is based upon many factors. Sometimes surgery
is put off until full growth is reached, even if the curve is getting
Spinal fusion is often more successful in children and teenagers
than adults because spine is more flexible in younger patients and
complications are fewer.
Surgery for scoliosis is major surgery that comes with risks but
the benefits usually outweigh the risks for those with severe curvatures.
Scoliosis, left untreated, can lead to deformity, physical problems
(crowed lungs, back pain), and low self esteem which can affect
every aspects of one’s life.
Are there Other Treatments for Scoliosis besides Back Braces
Studies have shown that exercises and chiropractic treatment will
not help scoliosis. Back
bracing and surgery are the only treatments shown to be the only
effective treatment for Idiopathic Scoliosis. The use of a back
brace usually prevents scoliosis from progressing any further.
If the curve becomes severe spinal fusion surgery is usually recommended.