Doctor and patient with scoliosis review treatment plans at Texas Scottish Rite Hospital for Children

What Is Scoliosis?

Scoliosis is a progressive condition, not a disease, causing the spine to curve or twist into a “C” or “S” shape. Signs and symptoms include uneven shoulders, shoulder blade prominence and waistline discrepancies. Scoliosis reportedly affects two to three percent of school-aged children and has a tendency to run in families. It most often affects 10- to 15-year-old girls. 

In congenital scoliosis, the cause is known. For example, a child may be born with a misshapen vertebra, one of the building blocks of the spine. A curve may also develop from an underlying neurological disorder (neuromuscular scoliosis). Most often, however, the cause is unknown, or idiopathic. Slouching, bad posture, sleeping position, lack of calcium or carrying heavy books, backpacks or purses does not cause scoliosis. It’s not the result of doing anything “wrong,” and there’s no way to prevent it.

Finding scoliosis is easy when examining the back closely, but it can be missed if you’re not looking for it. Sometimes clothes don’t hang properly. For example, one pant leg may be longer, or a skirt hem doesn’t look level. A shoulder blade may look higher and be seen through clothes or when wearing a swimsuit. Parents or friends might notice the curve, but most curves are found through a school-screening program or by a pediatrician. A trained examiner can detect even a slight curve when a child bends over to touch his or her toes.

We provide a multidisciplinary, patient-centered approach to treating scoliosis. Our experts analyze spinal maturity; the degree, extent and location of the curve; and the potential for progression. We then use this information to determine the best treatment option. From observation to bracing to surgery, we ensure that every child receives the highest-quality care.
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There are many types of scoliosis, and kids can develop it at any age. The most common form has a genetic component. Our doctors and researchers have recently linked the condition to three different genes.

Other types of scoliosis are far less common and can be caused by an abnormal shape of one of the vertebra (congenital scoliosis) or associated with an underlying neuromuscular condition (neuromuscular scoliosis).

Scoliosis is not the result of any behavior. And there’s no known vitamin, mineral or nutritional deficiency that leads to spinal deformity.

Scoliosis is a curvature of the spine into a “C” or “S” shape. A parent, school nurse or friend may notice a small difference in the shape of your back. You might notice that clothes begin to fit differently or that one hip is higher than the other. When you look in a mirror, you may see that one shoulder is raised or that you lean to one side. A doctor can confirm the condition with an X-ray.

Scoliosis does not usually hurt, and healthy teenagers shouldn’t have curve-related pain. If you do feel pain, it’s a good idea to schedule an appointment with your doctor for evaluation.

If your curve measures more than 10 degrees. Slight curves in the spine may not need any treatment other than periodic monitoring by your doctor.

If your nurse detects a spinal curve, the best thing to do is to see a pediatrician or general practice doctor, who can examine the curve and determine if it’s scoliosis. If your doctor confirms scoliosis, they can refer you to Scottish Rite Hospital for further evaluation. Your school nurse can also call our Patient Access department for additional information. An X-ray is not necessary for a doctor’s referral.

Braces are usually prescribed for those curves above 25 degrees in patients whose spines are still growing. Wearing a brace is the only effective nonsurgical way to prevent the curve from getting larger.

Your brace will be custom-made for your back’s shape. It shouldn’t hurt, but there will be some pressure applied to the side of the chest to partially correct the curve. You may feel some discomfort at first, but it should decrease over time. If your brace hurts while you’re wearing it, contact your orthotist to see if it needs an adjustment.

You can participate in almost every activity you currently enjoy while wearing the brace. Apart from wearing it to school and while at home, you might be able to take off your brace while competing in certain sports or activities. The more you wear it, the more effective it will be at aligning your spine. Read more about our bracing study that was featured in The New York Times.

The primary goal of scoliosis surgery is to stop the curve from getting worse. The secondary goal is to correct deformity. Through surgery, the physician safely corrects the curve while maintaining balance of the spine. An average amount of correction is usually 50 to 80 percent of the curve.

Surgery is usually done from the back, leaving a scar on the middle of the back. If the surgery is done through the side, the scar is on the side. The length of the scar depends on the number of curves that need to be corrected. Every patient’s situation is different, but the scar usually heals as a thin white line within a year of operation. 

Children can typically return to school approximately three weeks after the surgery, but lifting heavy objects, such as backpacks, is discouraged for several months.

For the first month, limit activity to walks and light chores. Depending on your type of surgery and other factors, you may be ready for light sports as early as three months after surgery, and back to full activity at six months. In general, you should avoid heavy lifting, bending or twisting for approximately six to nine months.

The specialists in our Center for Excellence in Spine have spent a lifetime treating, researching and pioneering care for scoliosis, so kids around the world can stand a little taller. Our Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine Research was established in 2005 to determine the cause of scoliosis, better understand factors that lead to curve progression, explore ways to prevent curve progression and improve treatments. This revolutionary center provides a forum for experts from diverse disciplines to collaborate on specific challenges related to spinal deformities.

In April 2007, our researchers identified the first gene – CHD7 – associated with idiopathic scoliosis. In 2011, they identified two additional genes – CHL1 and DSCAM – that give new insight into the condition. These gene discoveries lay the groundwork for future research and may lead to improved scoliosis prevention and treatment methods.

Many of our scoliosis patients participate in one or more of our various research studies. Our Pediatric Scoliosis Database currently contains information collected over the past 15+ years on more than 1,500 individuals with idiopathic scoliosis (with hundreds more and their family members participating in our Genetic Scoliosis Database). Information such as age, weight, family history, age of onset, scoliosis progression over time and clinical measurements can easily be compared and linked to clinical, radiographic and laboratory data. The database will ultimately integrate information for several hundred research participants with idiopathic scoliosis in the next three to four years. Learn more.

The specialists in our Center for Excellence in Spine develop leading-edge technologies to improve scoliosis treatment around the globe.

The Scottish Rite Hospital Spinal System has been widely used for the treatment of spinal deformities for nearly two decades. The experts in the center have enhanced the system to improve the surgical treatment of this complex condition by using and innovating various surgical technologies. Learn more.

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