Scoliosis

The orthopedic program at Le Bonheur Children’s Hospital is nationally ranked as one of the best children's orthopedic programs by U.S. News & World Report. Our team of pediatric orthopedic and spine surgeons specialize in the diagnosis and treatment of scoliosis. Le Bonheur Children’s offers a specialized clinic dedicated to the treatment of scoliosis. Physicians, nurse practitioners, residents, orthopedic nurse coordinators, orthotists and orthopedic nurses provide patient-and-family-centered care in our pediatric scoliosis program.

Learn more about the Campbell Clinic Pediatric Spine Center at Le Bonheur.

What is Scoliosis?

A normal spine, when viewed from behind, appears straight. However, scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater on x-ray.

Scoliosis is a type of spinal deformity and should not be confused with poor posture. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis.

Causes of Scoliosis

In most cases, the cause of scoliosis is unknown- a condition called idiopathic scoliosis. Other types of scoliosis include congenital scoliosis which is present at birth and neuromuscular scoliosis which is associated with other neurological conditions.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five out of every 1,000 children develop spinal curves that are considered large enough to require treatment.

Adolescent Idiopathic Scoliosis occurs in children from 10 to 18 years of age. This is the most common type of scoliosis and is more commonly seen in girls.

Symptoms of Scoliosis

The following are the most common symptoms of scoliosis. However, each child may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head is not centered with the rest of the body
• difference in hip height or position
• difference in shoulder blade height or position
• when standing straight, difference in the way the arms hang beside the body
• when bending forward, the sides of the back appear different in height

Scoliosis Diagnosis

In addition to a complete medical history and physical examination, X-rays are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician or nurse practitioner measures the degree of spinal curvature on the X-ray.

The following other diagnostic procedures may be performed:

• Magnetic Resonance Imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
• Computed Tomography Scan (also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
• EOS imaging system – a scan that captures head-to-toe images of children in a standing, weight-bearing position. The system provides considerable reduction in radiation dosage – up to 89 percent less than CT – and captures images in less than one minute. Le Bonheur is only one of a few children’s hospitals in the country to offer the technology.
• SCOLISCORE – a genetic test to determine curve progression. Understanding the progression of the curve allows doctors to develop a more personalized treatment plan.

Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present

Treatment of Scoliosis

Once you visit the clinic at Le Bonheur, a specific treatment plan will be developed by your doctor or nurse practitioner. Treatment is based on the following:

• your child's age, overall health and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures or therapies
• expectations for the course of the condition
• your opinion or preference
• surgery including anterior and posterior spinal fusion, spine stapling and VEPTR.

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

• observation and repeated examinations
• bracing
• surgery

Scoliosis Surgery

If the curve is severe, children may require surgical correction for scoliosis. Surgical treatments are almost always performed when the child has reached teenage years. Surgical options available at Le Bonheur Children’s include spinal fusion and spine stapling in select cases. Spinal fusion is a surgery that joins the vertebrae together to straighten the spine. Spine stapling is an alternative for to spinal fusion for some patients that corrects the curve without fusing the spine.

Young children or those with severe spinal deformities may be treated with a vertical expandable prosthetic titanium rib (VEPTR). A VEPTR is a metal rod curved to fit the back of the chest and which is lengthened to grow with the child. During a surgical procedure it is attached to the rib cage or pelvis to help the spine become straighter allowing for improved breathing and lung development.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation and corrective exercise) prevent the progression of the disease.

Long-term outlook for a child with scoliosis

The management of scoliosis is individualized for each child depending on his/her age, amount of curvature and amount of time remaining for skeletal growth. Scoliosis requires frequent examinations by your child's physician or nurse practitioner to monitor the curve as your child grows and develops. Early detection is important. If left untreated, scoliosis can cause problems with heart and lung function.

Choose Le Bonheur Children’s for Scoliosis Treatment

Le Bonheur Children’s Hospital and the Campbell Clinic Pediatric Spine Center is a center of excellence dedicated to the treatment and research of all pediatric spinal conditions, including scoliosis. Le Bonheur Children’s offers a specialized clinic dedicated to the treatment of scoliosis, and all of our pediatric orthopedic specialists are board certified and fellowship trained in pediatric orthopedics. Children from across the country visit Le Bonheur each year for scoliosis treatment.