Scoliosis | Diagnosis & Treatment

How is scoliosis diagnosed? 

Scoliosis can be difficult to diagnose. Some spinal curves are visible and obvious, but in other cases, they are not. Curvature of the spine often causes no back pain and usually progresses slowly. 

Scoliosis is often overlooked until a child reaches early puberty and starts growing rapidly. But early diagnosis is an important part of successful treatment. For this reason, pediatricians, family physicians, and some school programs routinely look for signs of scoliosis in children and pre-teens. 

The Adams Forward Bend Test is a common method used to diagnose scoliosis. The patient puts their hands together and bends forward with straight knees, making their spine visible. The clinician looks for unevenness in the hips, ribs, or shoulders. If they see a curve, they may use a scoliometer, a flat piece of metal about the size of an index card, to measure the degree of the curve. A curve of more than five to seven degrees on the scoliometer may indicate scoliosis.

Scoliosis test with Scolimeter. Illustration of diagnosing scoliosis.  

Determining the degree of curvature

If your child has scoliosis, their doctor will gather further information about their spine by asking questions about any family history of scoliosis, doing a physical examination, and looking at an x-ray of the child’s spine. This will help the clinician determine:

  • the shape of the curve - whether it is an “S” or “C” shape and whether the ribs and muscles are involved
  • the direction of the curve - whether the spine curves to the left, right, or both
  • the location of the curve - whether the curve is in the upper or lower spine or both 
  • the degree of the curve - whether the curve is mild, moderate, or severe

Scoliosis Treatment

 

How is scoliosis treated? 

Treatment for scoliosis depends on the type of scoliosis, your child’s age, and severity of the curve. In a young child, a mild curve of the spine has the potential to become worse as the child grows and develops. In an older teen who has reached their mature height, a mild curve may not be a problem. In most cases, scoliosis can be treated without surgery. Your child’s doctor will determine a treatment plan and follow-up based on what they learn from the x-rays and physical exam.

Treatment without surgery

Observation and monitoring

Children with a mild curve, less than 25 degrees, are typically monitored at regular doctor visits to be sure the curve does not get worse. Monitoring is particularly important during growth spurts, which typically take place in girls between the ages of 10 and 14 and in boys between the ages of 12 and 16. 

Physical therapy

The goal of physical therapy is to maximize your child's physical function so scoliosis will not prevent them from leading an active life. A physical therapist will teach your child exercises that can address pain and imbalance. Physical therapy requires a commitment on your child’s part to do the exercise as prescribed, often for up to an hour or more a day. 

Schroth therapy combines breathing exercises and physical movement. It is sometimes combined with other forms of physical therapy for patients with scoliosis.

Bracing

If your growing child's curve is between 25 and 45 degrees, or if it is getting worse, their physician may recommend bracing. A scoliosis brace will be specifically designed for your child and their particular curve. The brace holds your child's spine in a straighter position while they’re growing to partly correct the curve or prevent it from increasing.

Illustration of scoliosis bracing treatment.

Casting

In certain situations, particularly for infants and toddlers with scoliosis, doctors recommend a cast. A cast serves a similar purpose as a brace, it prevents an abnormal spinal curve from becoming worse as the child grows. Casts are typically changed every two to three months, depending on the child’s age. 

Treatment with surgery 

Despite everyone's best efforts, some curves do not respond to bracing or are too severe to treat with bracing. In such cases, these patients will need surgery. When possible, surgeons delay surgery until after a child’s growth spurt. 

Spinal fusion

Spinal fusion surgery is the most common surgical treatment for severe scoliosis in adolescents. Using metal rods, hooks, screws and wires (known as instrumentation), the procedure straightens the spine and solidifies the bone to prevent further abnormal curving. For 6 to 12 months after surgery, the spine fuses in much the same way that a broken bone heals. The child may need to wear a brace during this time. The instrumentation typically remains in the back without causing any problems.

A preview of surgery day

Patients scheduled for spinal fusion surgery and their families spend an immersive afternoon in a simulated surgical area as they prepare themselves for surgery. 
 

Treatment for young children

Scoliosis treatment is different for very young children whose spines are at an earlier state of growth. Options for early-onset scoliosis include: 
  • Casting may be used instead of bracing for young children who struggle against being put in a brace. Casts need to be changed every two to three months while the child is under anesthesia.
  • Growing rods, temporary implants that control spinal curvature as a child grows. The rods are attached to the spine with screws. About every six months, a surgeon lengthens the rods through a small incision in the back to allow the child’s spine to continue growing. 
  • MAGEC (MAGnetic Expansion Control) System, an adjustable growing rod system that uses magnetic technology to lengthen the rods without surgery. After an initial operation to implant the MAGEC system, the surgeon periodically lengthens the rods using a remote control.
  • Expansion thoracostomy/VEPTR™ is an expandable titanium rib used for children with underdeveloped chests. By keeping the chest wall expanded, the VEPTR creates room for the lungs to develop and the spine to grow straight instead of curved. 

What is the long-term outlook for children with scoliosis?

Most children and teens diagnosed with scoliosis can look forward to normal, active lives. Your child’s outlook depends in large part on the nature and severity of their scoliosis. Age also plays an important role. Early diagnosis and treatment can improve the outlook for many children with scoliosis.