Scoliosis (Idiopathic, Neuromuscular and Congenital)
If your child has scoliosis, Gillette Children’s can help. Gillette is a nationally and internationally recognized leader in pediatric orthopedics and in the treatment of pediatric spine conditions, including scoliosis.
Whether your child has idiopathic, neuromuscular or congenital scoliosis, the primary goal of any treatment is to stop the curve from getting worse. Regardless of severity, scoliosis pain is rare. In many cases, surgery isn’t necessary if scoliosis is detected early and your child receives proper care.
Most patients with mild scoliosis at skeletal maturity (when the spine is no longer growing) will lead a normal life with no limitations on activities, including sports.
However, for patients with more significant curves, there is a higher likelihood that the curve will continue to progress throughout adulthood. Although it will progress slowly (0.5-1 degree per year), throughout a lifetime this can add up to a significant curve which can be more difficult to correct and have an impact on quality of life.
Options for how to manage your child's scoliosis depend upon the size of their curve and how much growing they have left to do.
Management of Scoliosis
The way that Gillette cares for scoliosis largely depends upon what type of scoliosis you have.
Infantile idiopathic scoliosis has the highest rate of spontaneous resolution. For smaller curves the first line treatment is observation. Your spine provider will want to monitor your child’s curve with an exam and x-rays every 4-6 months. They will make measurements on the x-ray to monitor for a possible change in curve size; including Cobb angle and rib vertebral angle difference (RVAD). Your provider may want to get an MRI to evaluate for other causes of scoliosis.
If the curve is moderate in size and/or increasing, your provider may recommend a non-surgical intervention, such as casting or bracing, to prevent or slow progression.
For smaller curves, observation is the first-line treatment. Your spine provider will want to monitor your child’s curve with an exam and x-rays every 4-6 months. They will make Cobb angle measurements on the x-ray to monitor for a possible change in curve size.
With moderate curves we may recommend a brace to try and prevent the curve from worsening. The type of brace that is recommended depends upon how big your curve is, where your curve(s) are within your spine, and how fast you are growing.
If you are prescribed a brace, your provider will want to see you every 4-6 months to check-in regarding symptoms, brace comfort and wear pattern; get an x-ray of your spine; see how fast you are growing, and do an exam. It must be emphasized that the purpose of the brace is to slow the progression of the curve, not to straighten the curve. Learn more about bracing to treat scoliosis.
For larger curves, a brace may not be able to help and the best treatment may be surgery. If your child is a candidate for scoliosis surgery, your provider will discuss the options with you.
Scoliosis curves that occur in younger children may be caused by an underlying abnormality in the spine or the spinal cord. The most common diagnoses are chiari malformation, spinal cord syrinx, or tethered spinal cord. These abnormalities occur in approximately 20% of JIS patients. Your provider may want to get an MRI to be sure there aren’t underlying causes that are contributing to or causing the scoliosis.
There are 4 main pathways of AIS management. Some patients stay on one pathway the entire time they are seeing a spine provider and some will move to different pathways. It depends on your unique curve and how you and your curves are responding to the treatment recommendations.
Pathway 1: You have scoliosis but we don’t need to do anything, not even check it.
With mild curves in patients who are skeletally mature and are not growing anymore, the curve has a very small chance of getting worse. These curves are mild enough that they are not causing symptoms. We are happy to see you if you develop any problems with your spine or if you have a concern, but we do not need to see you on a regular basis.
Pathway 2: You have scoliosis and we need to monitor it.
With mild curves in patients who have growth remaining or moderate curves in patients who are done growing, we will see you on a regular basis to monitor your curve. Your provider will want to see you every 4-12 months to check in with you regarding symptoms, get an x-ray of your spine, check your height, and do an exam.
Pathway 3: You have scoliosis and we need to intervene to try and prevent it from getting worse.
With moderate curves in patients who have growth remaining, we often recommend non-surgical treatment to try and prevent the curve from worsening. The most effective non-surgical treatment for AIS is wearing a brace. The type of brace that is recommended depends upon how big your curve is and where your curve(s) are within your spine. Your provider may also recommend adding scoliosis-specific physical therapy to the bracing treatment.
Your provider will want to see you every 4-6 months to check in regarding symptoms, brace fit and wear pattern, get an x-ray of your spine, check your height and do an exam.
Pathway 4: You have scoliosis that is severe and we need to perform surgery to treat it.
As mentioned above, curves that are significant, progressive, or do not respond to bracing are likely to cause lifelong complications. It is because of this that we recommend surgical intervention to correct the curve to prevent it from getting worse. The two most common surgical procedures we do for AIS are posterior instrumented spinal fusion (PISF) and vertebral body tethering (VBT).
What to Expect During Your Visit?
A very important piece of managing your scoliosis curve is being able to accurately measure the curve and see how it’s changing. Getting an x-ray of your spine is the best way to do this.
Some of our clinics have a special x-ray machine called EOS. The EOS Imaging System is a unique system that captures the x-ray while you’re sitting or standing up; and uses an ultra-low dose of radiation. It provides a detailed image so we can make more informed diagnoses and create an individualized treatment plan. Reducing radiation is particularly beneficial for children who need to be imaged frequently, such as those with spinal conditions like scoliosis.
Your provider may want an MRI of the spine if there is concern for other causes of scoliosis. An MRI does not use any radiation, but takes up to one hour and requires the patient to lay very still. Because of this, some patients may need medicine to make them sleepy and remain still for the MRI. This is discussed on a case by case basis.
Monitoring Your Growth
We will measure your height at each visit. This lets us calculate how fast you’ve grown between visits, or your rate of growth. Knowing where you are on the rate of growth curve helps us to make the best decision for managing your specific curve.
There are multiple clues on your x-ray that help your provider determine how much growth you have left. We can use growth plates in your hand bones, upper arm bone, and pelvic bone to get more information on your skeletal maturity.
Non-surgical Treatment Options
Vitamin D3 and Calcium Supplementation
Research suggests that Calcium and Vitamin D3 supplementation may help to reduce the risk of curve progression in patients with Idiopathic Scoliosis. We recommend that you take:
600 mg of Calcium and 800 IU of Vitamin D3 daily
Many pharmacy chains carry this dose of Calcium or Vitamin D3 in one pill. This is a common over the counter supplement and does not require a prescription. Please notify your pediatrician that you are taking this supplement at your next well child examination. Patients with a history of kidney stones should consult their primary care provider before taking extra calcium.
When spinal curves progress to a more significant degree, surgery may be the best option. For those who may benefit from surgery, the two options are spinal fusion and vertebral body tethering. Learn more about Scolios Surgery.
Scoliosis can range quite a bit from mild to severe. Whether your child has minor curvatures and is otherwise healthy, or has complex underlying conditions, highly trained experts at Gillette can help manage your child’s spine condition.
Your child deserves a lifetime of excellent health care—from birth through adulthood. The family-centered environment at Gillette is designed to help your child achieve the highest possible levels of health, independence and happiness.
You’ll get help navigating the services you need to treat your child. The specialties and services most often involved in scoliosis care include:
Get a Second Opinion
Getting a second opinion is particularly helpful with a complex or unclear diagnosis or treatment that is no longer working. Often having another expert’s opinion can help you feel more knowledgeable and confident when taking the next steps to care for your child.