October 04, 2021
Scoliosis, a common, sometimes hereditary spinal condition, is a curvature of the spine that affects 2% to 3% of the population in the United States, or an estimated 6 million to 9 million people.
But with new opportunities for treatment that didn’t exist even a few years ago, providers are better equipped than ever to help stop the curve before it gets to a point where a person needs surgery, says Michael Vitale, MD, the Ana Lucia Professor of Orthopedic Surgery at Columbia University Vagelos College of Physicians and Surgeons and chief of pediatric spine surgery at NewYork-Presbyterian Morgan Stanley Children’s Hospital and NewYork-Presbyterian Och Spine Hospital.
“If your child has scoliosis, don’t be afraid of it,” Vitale says. “The key is being aware of it and getting the diagnosis early so you can begin treatment. When treated early, there’s a lot of hope for stopping curve progression and allowing kids to live a perfectly active, normal life.”
- The most common type starts just before puberty.
The most common form of scoliois, called adolescent idiopathic scoliosis, is most often detected between the ages of 10 and 15. Children typically have a spine check each time they have an annual physical with their pediatrician, Vitale says, and often also by the school nurse.
- See a specialist.
If there’s any asymmetry detected in your child’s shoulders, shoulder blades, spine, or pelvis, see a pediatric spine specialist to have an X-ray performed. If scoliosis is present, the doctor can measure the degree of curvature.
This specialization matters, says Vitale, because places like Columbia University Irving Medical Center and NewYork-Presbyterian Och Spine Hospital, see a lot of children with scoliosis and employ a number of scoliosis-specific physicians, physical therapists, and orthotists (experts who make braces) who have the depth of experience to diagnose and treat all forms of scoliosis.
- Early diagnosis is key.
Vitale says treatment for children with a spinal curve of about 25 degrees can be treated without surgery by using scoliosis-specific physical therapy, vitamin D supplementation, and, sometimes, a brace.
There have never been better treatment options for children with scoliosis, Vitale adds. With more accurate body scans, X-rays that use barely any radiation, and more advanced bracing, the sooner treatment starts, the less likely it is that patients will need surgery, and the healthier they will be.
- Not all braces are the same.
When a brace is needed, Vitale says, talk to your scoliosis doctor about custom-fitting your child with an external brace (a vest-like garment) to keep the scoliosis from getting worse and to maintain an upright spine. “We choose the most effective brace that your child is most likely to wear as prescribed,” he says.
A child should wear the brace as recommended for full benefit: 16 to 18 hours every day until he or she stops growing. This will help establish that the spine straightens adequately and will stay straight into adulthood.
- Scoliosis-specific physical therapy can help.
A physical therapist teaches specific exercises and corrective breathing techniques to develop the inner muscles of the rib cage and change the shape of the upper trunk to help slow or stop curve progression.
- When the curve reaches 50 degrees, surgery is usually necessary.
If surgery is needed, many treatment options are available, depending on the age of the child. For younger children, growing rods are often used—including some that can be periodically lengthened by using magnets to remotely control rods that were implanted in the spine—to avoid additional surgeries.
“Tethering” of the vertebrae with screws and cords placed in the spine is a treatment option for somewhat older children who are still growing. Fusing parts of the spine in an operation through the back is the standard of care for most adolescents and teenagers.
- Scoliosis is not just a cosmetic problem.
Scoliosis that remains untreated can get worse. Once the curve hits the 70-degree stage, lung function may be impaired. Curves of 90 degrees or more can worsen both lung and heart function.
- Children with scoliosis who receive treatment can live normal, active lives.
Even in the subset of patients who do need surgery, treatments have continued to evolve and improve and outcomes are typically great, Vitale says. Often kids can get back to full sports activities, including gymnastics and dance.
Michael G. Vitale, MD specializes in the nonoperative and operative treatment of complex pediatric scoliosis and other spinal disorders and performs approximately 200 scoliosis procedures every year, half of which are in children less than 8 years old. As part of his commitment to innovation in scoliosis treatment, Vitale helps to lead the Pediatric Spine Study Group, which conducts extensive multicenter international research focused on improving the care of young people with scoliosis.