Scoliosis

Someone with scoliosis may have a back that curves from side to side like an "S" or a "C." Small curves generally do not cause problems. If the curve gets severe, it can be visible and cause discomfort. If a curve gets really severe, it can even affect a person's breathing and heart. A very severe curve can lead to damage in the joints of the spine. This might get painful when the person is an adult.

Scoliosis is a bit of a medical mystery. No one knows for sure what causes the most common form of scoliosis, idiopathic scoliosis.

Doctors do know that scoliosis can run in families. So someone with scoliosis may have family members who also have it.

Most types of scoliosis are more common in girls than boys. Girls with scoliosis are more likely to need treatment than boys are.

How Is Scoliosis Diagnosed?

Sometimes scoliosis will be easy to see. A curved spine can cause someone's body to tilt to the left or right. Many teens with scoliosis have one shoulder blade that's higher than the other or an uneven waist with a tendency to lean to one side.

Because scoliosis can develop very gradually, it often isn't diagnosed until a person is between the ages of 10 and 14.

Doctors routinely check teens for scoliosis during regular physical exams. Some schools in the United States also test for scoliosis, but the most accurate way to diagnose it is to see a doctor.

What Do Doctors Do?

If a doctor thinks the curve isn't a problem, a person might not need any treatment, just regular checkups to make sure the curve doesn't become larger. To get a clearer view of the spine, doctors might order X-rays. If the exam or X-rays show a significant curvature, the person is referred to an orthopedist.

If you see an orthopedist, he or she will examine you and study X-rays of your spine. You may hear the orthopedist mention something called a Cobb angle. The Cobb angle is a measure of the curvature of the spine in degrees, and the number of degrees helps the doctor decide what type of treatment is necessary.

A scoliosis curve of 10 to 15 degrees usually means that nothing needs to be done except for regular checkups until the person has gone through puberty and finished growing (the curvature of the spine usually doesn't get worse after that point). If the curve is 20 to 40 degrees, the orthopedist will generally suggest a back brace. A Cobb angle of 40 or 50 degrees or more may mean that surgery is needed.

Treating Scoliosis

About 1 in 5 teenagers with scoliosis needs to wear a back brace. Back braces today are much lighter and more comfortable than they used to be — and researchers are developing even better ones all the time.

There are several different types of braces. Some braces are worn for 18 to 20 hours a day, others only at nighttime. Which one the orthopedist chooses depends on the person, where the curve is on his or her back, and how severe the curve is.

The brace acts as a holding device that keeps the spine from developing more of a curve. A brace won't ever make the spine straight. But if it does its job well, the curve won't increase more than 5 or 10 degrees and may prevent the need for surgery.

Sometimes, even with a brace, someone with severe scoliosis will need surgery to correct the curve. During the operation, the orthopedic surgeon does a procedure called a spinal fusion. This causes some of the separate bones in the spine to link or "fuse" together, so that the spine can no longer continue to curve. The surgeon also uses metal rods, hooks, screws, and wires to correct the curve and hold everything in line until the bones heal. The metal parts are placed deep under the spine muscles. In most cases they can't be felt and do not hurt.

An operation to correct scoliosis takes several hours, depending on how big the curve is and how many bones need to be fused. Normally, a patient doesn't need a brace or cast after surgery. A patient will be able to get out of bed the day after the operation and start to walk.

Most teens who get scoliosis surgery can leave the hospital in less than a week, usually go back to school about a month after surgery, then return to some activities in 3 or 4 months. Most should be able to go back to all normal activities after 6 to 12 months. But of course each patient's surgery and recovery might be different, depending on the type of surgery and the person's age.

After about a year, the bones should be fully fused. Although the metal rods are no longer needed, they are left in the patient's back because they aren't doing any harm and taking them out would involve another operation.

People with scoliosis can have active, normal lives. Doctors don't know of any activities (including things like sports or carrying a backpack) that make scoliosis worse. So people who have scoliosis should still be able to play their favorite sports and carry on as normal after they recover from surgery.