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Scoliosis in Children: To Treat or Not to Treat?

June 05, 2014

Scoliosis is a disordered growth that creates a rotation in the spine. It’s typically diagnosed in pre-teen or teenage children and is far more common in girls (90 to 95 percent) than in boys (five to 10 percent). A little more than one percent of the population, or 3.5 million people, have scoliosis.

The most common type of scoliosis is adolescent idiopathic, which occurs and progresses during a child’s preteen growth spurt. In general, this type of scoliosis is asymptomatic. Although back pain can occur with scoliosis, even fairly large curves generally do not cause much pain.

Treating Scoliosis
The goal of scoliosis treatment is to correct the deformity – it’s not for pain control.  When considering how to treat a child’s scoliosis, we look at three important numbers or ranges:

  • 10 degrees – If the curve is below 10 degrees, it’s not scoliosis.
  • 25 degrees – If the curve is around 25 degrees to 30 degrees, we’ll most likely have the child wear a brace to guide growth and hopefully halt the progression of the deformity.
  • 45 to 50 degrees and above – This is the tipping point or the threshold for surgery. Beyond this range, even after growth, the curve will likely keep progressing as the child ages by about one degree per year. This means that a 50-degree curve in a 15-year-old will progress into a big curve (around 110 degrees) in adulthood.  A 110-degree curve will be outwardly noticeable and create a lot of dysfunction, so it is important to correct the deformity with the surgery while the person is young.

Scoliosis Surgery
As people age, their backs get stiffer and the ability to correct scoliosis with surgery diminishes.  A person’s ability to tolerate the surgery also lessens.  It is much easier to correct scoliosis with surgery when a person is around age 14-15. We can typically correct the curvature by 50 to 60 percent, and teenagers heal remarkably well.  But again, this is a deformity operation, not something that will help control back pain. (Most people with scoliosis don’t even have back pain anyway.)

During scoliosis surgery, a surgeon fuses the bones of the spine together with screws and rods.  One rod is rotated to help correct the curvature of the spine, and a second rod helps hold things in place.

Some people think that scoliosis causes poor lung function, but this is not exactly true.  The curve has to be pretty large (80 to 90 degrees) for a noticeable decline of lung function, coupled with a person exerting a maximum amount of energy.  It’s important to know that scoliosis surgery generally does not help improve lung function and is not a life-saving measure.

After Scoliosis Surgery
A teen who undergoes scoliosis surgery will spend three days to one week in the hospital and is sent home once he or she can walk and perform normal activities.  For six to nine months, we advise no sports or strenuous activity.

The long-term effects of scoliosis surgery are difficult to research.  It’s challenging to follow patients for very long periods of time (70 years) to observe how surgery affects them throughout their life.  However, we do know that even 15 to 20 years after surgery, patients who have undergone scoliosis correction are generally happy with the results and have an improved self-image as well as more confidence when compared to those who did not have the surgery. Additionally, fertility is not affected nor is the patient’s ability to play sports or perform other activities they may desire.

Dr. Conor Regan treats all disorders of the cervical, thoracic, and lumbar spine, including adult and pediatric spinal deformity. He has special interests in the cervical spine and complex cervical reconstruction as well as lumbar revision surgery and treatment of cancer of the spine. He is trained in the treatment of idiopathic scoliosis. To learn more about Wake Orthopaedics, visit their website.  Call 919-232-5020 to make an appointment.

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