DEAR MAYO CLINIC: Is wearing a brace full-time the only treatment option for a child with scoliosis? What are the risks of not getting treatment?
ANSWER: Although braces commonly are used to treat scoliosis, they aren’t the only option. The right treatment choice depends mainly on a person’s age and the size of the curve. Mild cases of scoliosis may not need treatment. But, moderate to severe scoliosis that is left untreated can lead to pain and increasing deformity, as well as potential heart and lung damage.
Scoliosis is a sideways curve of the spine with rotation. It most often develops during the growth spurt just before puberty. If the spinal curve is small — less than about 15 degrees — then having it checked periodically may be all that’s needed. Most of the time, these small curves don’t get worse over time.
When the curve is in the 20- to 40-degree range, however, and a child has at least two years of growth remaining, that’s when a brace typically is a good choice. Wearing a brace doesn’t cure scoliosis or reverse the curve, but it usually prevents the curve from getting worse.
The most common type of brace is made of plastic and is contoured to a child’s body. It fits under the arms and around the rib cage, lower back and hips. To be most effective, the brace must be worn day and night. Children who wear a brace for scoliosis usually can participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities. A child stops wearing the brace once his or her bones stop growing. A brace won’t help older teens and young adults who are diagnosed with scoliosis after they have stopped growing or patients with severe curves. In those situations, most doctors recommend surgery.
In general, surgery is also the first step in treatment for curves that are large ― usually greater than 50 degrees. The standard surgery for scoliosis is spinal fusion. This procedure corrects the curve of the spine by connecting two or more of the spinal vertebrae. Metal screws and rods are used to hold the vertebrae together, so they can heal into one solid unit.
A newer surgical option is anterior vertebral body tethering. It involves inserting screws into the vertebrae affected by scoliosis. The surgeon attaches a cord to each of the screws and then pulls and secures the cord. The vertebrae are cinched together on one side and splayed open on the other, correcting the curve. This aligns the spine and gives the vertebrae space to grow in properly. This surgery is used mainly for cases of significant scoliosis in children with growth remaining. Mayo Clinic is one of only a handful of centers where this surgery is performed.
If moderate to severe scoliosis is not treated, it usually continues to progress at an average of one degree per year. Significant spinal deformity leads to noticeable changes in appearance, such as shoulders that are not level, ribs on one side of the body that stick out farther than on the other side, uneven hips, and a shift of the waist and trunk to the side. It also can cause increased back pain, and, in rare occasions, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.
If you notice that your child’s spine seems to be curved, or if you spot other signs and symptoms of scoliosis — such as uneven shoulders or an uneven waist, one hip higher than the other, or one shoulder blade that seems more prominent than the other — make an appointment to have it evaluated as soon as possible. — Dr. Todd Milbrandt, Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota