Still flexible after scoliosis surgery

An innovative procedure called spinal tethering corrected Audrey's scoliosis while retaining her mobility. Read her story >

Scoliosis

What is scoliosis?

Scoliosis is a condition in which a child’s spine curves from side to side so that it looks more like an S or a C than a straight line. These curves can also make the shoulders, waist, or hips look uneven. It may look as if the child is leaning to one side. The curve can happen on the right or left side of the spine, or it can happen on both sides in different sections. Both the middle (thoracic) and lower (lumbar) spine may be affected.

When there is no known cause (as in more than 80% of cases), the condition is called idiopathic scoliosis. It is most commonly seen in girls ages 10 to 18, but children of all ages and genders can get idiopathic scoliosis. Scoliosis falls into three general age brackets:

  • Infantile (birth to age 3): More common in boys; may resolve as the child grows.
  • Juvenile (ages 3 to 10).
  • Adolescent (ages 10 to 18): Most common in girls.

Another kind of scoliosis, known as neuromuscular scoliosis, is less common. Neuromuscular scoliosis can develop in patients with other conditions, including:

Our combined team of neurosurgeons and orthopedic surgeons have more years of experience treating both idiopathic and neuromuscular scoliosis than any others in the Bay Area.

What are the symptoms of scoliosis?

Scoliosis usually doesn’t cause much pain. Small spine curves often go unnoticed by children and their parents and are first detected during a school screening or by the child’s pediatrician during a regular checkup.

Symptoms of scoliosis include:

  • One shoulder is higher than the other, or one shoulder blade sticks out more than the other.
  • The head is slightly tilted to one side of the body.
  • The child’s body leans to one side.
  • One leg is longer than the other.
  • One hip sticks out more than the other.
  • The rib cage seems uneven or crooked—one side sticks out more than the other or creates a hump on one side of the back when leaning over.
  • The arms hang beside the body differently when the child stands straight.
  • The heights of the sides of the back are different when the child bends forward.

These symptoms may seem like other back problems, or they may be a result of an injury or infection. Ask your child’s pediatrician about a diagnosis.

What causes scoliosis?

Carrying heavy bags, poor posture, or sports don’t cause scoliosis. In fact, more than 80% of scoliosis cases don’t have a known cause. A child may be born with it or can develop it later in life. Scoliosis is most often seen in children between the ages of 10 and 18, and it tends to affect more girls than boys.

Possible causes of scoliosis include:

  • Nervous system problems, like cerebral palsy or muscular dystrophy.
  • Inherited conditions (passed on from parent to child).
  • Differences in leg lengths.
  • Injury.
  • Infection.
  • Tumors.

How is scoliosis diagnosed?

Your child’s pediatrician can diagnose scoliosis with a complete health history of your child and a physical exam. Your child may also need an x-ray to measure the degree of spinal curvature.

Finding scoliosis early is important for treatment. If left untreated, scoliosis can cause problems with heart and lung function. Health care providers, and even some school programs, routinely look for signs of scoliosis in children.

How is scoliosis treated at Stanford Medicine Children’s Health’s Pediatric Spine Center?

The goal of treatment is to stop the curve from getting worse and prevent deformity. We take a conservative, nonsurgical approach to treating scoliosis, and we consider other treatments first, such as physical therapy, bracing, and casting. We work with your child and family to select the best treatment option for your child’s needs. We also offer integrative pain management techniques as well as osteopathy. Lucile Packard Children’s Hospital Stanford has the only osteopathic physician in the country who focuses on pediatric pain. 

Non-surgical treatment options include:

Mehta casting is the standard treatment for young children with early-onset scoliosis, which means their spine curves too much at a young age. The cast can help prevent the spinal curve from getting worse as the child grows. The Mehta cast covers your child’s trunk, from the hips to just under the armpits. The belly area is open to allow space for the stomach to expand after eating. The cast is designed to push the spine in the correct direction over time. The cast is placed while your child is under general anesthesia, as infants and toddlers are unable to tolerate casting while awake. Children can usually leave the hospital after the cast is placed and after they awaken from anesthesia.

Depending on your child’s age, the cast will be changed every four to 12 weeks. This casting process will continue until your child is old enough to transition into a spine brace.

Bracing is the most common nonsurgical treatment option for children with adolescent idiopathic scoliosis. The brace is custom-made by an orthotist to fit to your child’s body shape and spine curvature. Braces apply gentle pressure to key places on the trunk of your child’s body. A brace helps keep your child’s spinal curve from getting worse as they grow when it is worn consistently, and it can help avoid spine surgery.

Types of spine braces

  • Rigo Chêneau and Wood Chêneau Rigo braces. The Rigo Chêneau and Wood Chêneau Rigo (WCR) braces are designed to correct the scoliosis curve from three dimensions. We partner with the Align Clinic to make fully customized braces for our patients. This company is the only certified maker of Rigo Chêneau braces in the Western United States. On-site orthotists—experts in making and fitting braces—are available in our Palo Alto and Pleasant Hill locations to save you a trip and to ensure close consultation with our doctors for the best possible fit.
  • Boston brace. The Boston brace has been in use for many years. It can be less conspicuous under clothing than other types of braces.

Fitting your child’s spine brace

Your child’s care team will work with you and your child to create a perfect-fitting brace. The process starts with an x-ray, taken with our EOS low-dose imaging system. After a physical exam, your child’s care team will discuss bracing options with you.

Your child’s orthotist will design and build your child’s brace. Orthotists from the Align Clinic are available at our Palo Alto and Pleasant Hill locations to make the fitting process more convenient and improve coordination between your child’s doctors and orthotist. 

Your child will likely need a new brace every 12 to 18 months as their body grows. Once your child is done growing, their doctors will decrease the number of hours your child wears the brace until they can stop wearing it.

Life with a spine brace

Braces are designed to be worn over a thin shirt or tank top, with your child’s normal clothing over the brace. Every situation is different, but many children and adolescents need to wear their braces for 18 hours a day to get the greatest possible benefit. Many kids choose to use some of the time without their brace for bathing, physical education and sports, and swimming. We encourage an active lifestyle, whether it may be sports or PE, to help maintain your child’s overall fitness and strength. 

We understand that wearing a brace can be a difficult adjustment, especially because many kids start wearing a brace when they are preteens or teens. We are here to help your child and family navigate this transition. Most kids adapt quickly and become comfortable wearing the brace at school, at home, and overnight. Your child will be able to continue doing his or her favorite activities and playing sports, sometimes with a few modifications.

Surgical treatment options for scoliosis

Surgery for scoliosis is needed when the curve in the spine becomes very severe and other treatments, like bracing, have not helped enough. Our spine team will discuss surgical treatment options with your family. Your child may need surgery if his or her curve measures 45 degrees or more on an x-ray or if bracing has not slowed down the progression of the curve. We understand that surgery can be scary, and we are here to help you understand all the options and choose the right one for your child. 

Children with severe early-onset scoliosis (those who develop scoliosis before the age of 10) may be candidates for an innovative procedure using Magnetic Expansion Control (MAGEC) growing rods to lengthen and straighten the spine. Our surgeon will decide if it is the right treatment option for your child’s specific scoliosis. MAGEC rods are used for younger children, as these rods are lengthened as your child grows.

During surgery, an orthopedic surgeon attaches the magnetic growing rods to the spine. After surgery, your child will have appointments every three months to lengthen the rods with an external remote control, helping your child’s spine grow along with the rest of his or her body. These lengthening procedures can be done in a normal clinic visit and take about 10 minutes, and they do not require any general anesthesia. 

Spinal fusion surgery uses rods, screws, and bone grafts to correct the spinal curvature as much as possible and prevent the curve from getting worse. We typically offer surgery to prevent curve progression later in life, which may lead to back pain, trunk imbalance, and impact on heart and lung function. There are two different kinds of spinal fusion surgery: through an incision either in the back (posterior) or the side (anterior). Your care team will carefully consider your child’s specific situation and decide if spine fusion surgery is the best option for your child; they will discuss with you which approach is appropriate for your child’s specific curve.

Anterior spinal fusion

Some curves are best corrected from the front of the spine, which involves making an incision on the side of the chest or abdomen. In anterior spinal fusion, the soft disc material between the vertebrae is removed and replaced with small pieces of bone (bone grafts), which will fuse the vertebrae together. Screws and rods can help provide stability during this process.

Posterior spinal fusion

Posterior spinal fusion is the most common surgery for adolescents with severe scoliosis. An incision is made in the back, and rods and screws are placed into the vertebrae to straighten them as much as possible and hold the spine in its new position. The surgeon then places bone grafts, or small pieces of bone, along the spine. Over time, the spine will fuse into solid bone in its corrected position.

Most children stay in the hospital for three to four days after surgery and miss three to five weeks of school. Your child’s care team will talk with you regarding the timeline in returning to activities and contact sports. 

Vertebral body tethering is an innovative procedure that corrects the spinal curve while maintaining mobility in the spine. The surgery is minimally invasive and involves making small incisions on the side alongside the ribs. The surgeon attaches screws and a rope to the vertebrae and applies tension to the cord to partially straighten the spine. The tension in the cord continues to straighten your child’s spine as he or she grows.

Your child’s care team will discuss your child’s surgical options with you, but vertebral body tethering is generally recommended for patients with adolescent idiopathic scoliosis who have a specific type of curve and with growth remaining. Since the procedure is minimally invasive, recovery takes about 10 to 14 days. 

ApiFix is a rod that expands as your child’s spine grows, helping to straighten the spinal curve. ApiFix differs from MAGEC growing rods in that ApiFix is for children and teens with adolescent idiopathic scoliosis, and it does not require office visits to lengthen the rod—it naturally expands as your child grows. The surgery to insert ApiFix is minimally invasive, done through a small incision in the back. ApiFix gives children and teens a better range of motion than spinal fusion. Your care team will discuss with you whether or not ApiFix is a good surgical option for your child. 

YouTube Play/Stop Button

Scoliosis: What is it and how is it treated?

In this video, hear from Meghan Imrie, MD, a pediatric orthopedic surgeon and spine specialist at Stanford Medicine Children’s Health, about how scoliosis is diagnosed and treated, and what patients can expect.

Radiation reduction during scoliosis treatment

Since many children with scoliosis need 20 or more x-rays to track the progression of their spine curve during treatment, we offer the EOS low-dose imaging system, which delivers 1/50th of the radiation of a typical spine x-ray. EOS captures both the front and side views—from head to toe—of your child’s body at the same time. This 3-D image helps our scoliosis experts make more accurate diagnoses and allows them to better track your child’s progress throughout treatment. EOS images also show the interactions between your child’s spine, hips, and legs, providing a more complete picture of your child’s condition and helping us develop a personalized treatment plan. Our Palo Alto and Pleasant Hill locations have the only EOS machines in the Bay Area that are dedicated to pediatric patients.

What to expect during your child’s first scoliosis appointment

Hearing that your child might have scoliosis can be scary, and we are here to help. During your child’s first visit, we will provide information and identify the best path forward for your child’s unique needs.

Your child may meet several members of the care team:

  • A pediatric orthopedic surgeon specializing in scoliosis treatment.
  • A nurse practitioner who has extra training in pediatric orthopedics.
  • If your child needs a spine brace, your child may meet with an orthotist, an expert in making and fitting braces.

During your child’s visit, we may take images of their spine or hand. We offer the EOS low-dose imaging system, which delivers 1/50th of the radiation of a typical spine x-ray. The hand x-ray helps us determine how much more your child’s bones will grow, which can impact treatment decisions. If your child already has an x-ray from their pediatrician, please bring it so we can look at it together.

Your child’s care team will conduct a physical exam and discuss the x-rays and exam findings with you. By the end of the appointment, you’ll leave with a diagnosis and next steps, which can include treatment or monitoring over time. 

What is life like for patients with scoliosis?

We understand that scoliosis can be a scary diagnosis. Thankfully, the vast majority of patients with scoliosis who are treated go on to live healthy, active, pain-free lives. Most patients with scoliosis can continue to play sports and participate in other activities while they are in treatment and beyond. And as they grow to become adults, most patients don’t have pain.

To learn more or schedule an appointment, please call (877) 463-0001.

Scoliosis Patient Stories