Spine Deformities & Scoliosis

Miller Children’s board-certified pediatric orthopedic surgeons are specially trained in pediatric spine trauma, spinal deformity and musculoskeletal abnormalities. The Orthopedic Specialty Center provides acute and chronic orthopedic care for infants, children and adolescents with skeletal (bone) maturity. The orthopedics care team provides comprehensive evaluation, diagnostic care, treatment and management for all spine disorders, including:

• Fractures and dislocations of the spine
• Spinal cord injury and trauma
• Spine conditions, such as scoliosis, kyphosis, spondylolysis and spondylolisthesis
• Neuromuscular disorders, such as cerebral palsy, spina bifida and muscular dystrophies
• Disorders of the cervical spine, including Klippel-Feil syndrome, upper cervical instability, Down's syndrome and swan neck deformity

Evaluation & Diagnostic Care

X-rays are the primary diagnostic tool to detect spine deformities, especially in scoliosis and kyphosis, and show atypical curve patterns or congenital scoliosis. The physician measures the degree of spinal curvature on the x-ray. Ortho diagnostic care will ensure proper diagnosis for this congenital or acquired hand condition. Some of these tests are done in the Imaging Center at Miller Children’s. Early detection is important for successful treatment.

Scoliosis

Scoliosis is the most commonly treated spine deformity. There are four types of scoliosis:

• Idiopathic scoliosis is the most common type of scoliosis. The cause is unknown, but there is strong evidence that it is inherited.
• Neuromuscular scoliosis results from abnormal muscles or nerves. It is frequently seen in people with spina bifida or cerebral palsy.
• Degenerative scoliosis results from bone collapse due to an injury, illness, osteoporosis, or previous back surgery.
• Congenital scoliosis is a type of birth defect that affects the development of the vertebrae. It may occur alongside other birth defects such as heart or kidney abnormalities.

Adolescents with a spinal curvature of less than 20 degrees usually do not require extensive treatment and have very little chance that the curve will grow bigger. They do, however, need periodic check-ups and x-rays to make sure the curve does not get worse. When a child is still growing, some small curvatures can get worse. If the curve gets larger than 25 degrees, treatment for scoliosis will start.

Non-surgical Scoliosis Treatment

If the spinal curve is 25 to 40 degrees and the child is still growing, a 24-hour brace is often worn. A brace is a hard plastic jacket, made especially for the individual child’s body, to push the spine to make it straighter. This is to stop the curve from getting worse until they stop growing. Bracing is an attempt to prevent further progression of the curve, but it will not reverse or cure scoliosis.

Scoliosis Surgical Treatment

Children who have spinal curves greater than 40 to 50 degrees are often considered for scoliosis surgery. Factors considered for recommending surgery include how mature the child’s bones are and the curve's rate of progression. While surgery will not perfectly straighten the spine, the goal is to make sure the curve does not get worse. Scoliosis surgeries are done in the state-of-the-art surgical center while children are under anesthesia.

Follow-Up Care

After the operation, children will recover in the hospital for up to one week, usually in the pediatric intensive care unit. During this time, physical therapists assist them with walking until they are comfortable enough to walk on their own again. Some children may have to wear a cast or brace to help support the spine while it heals. There are also some activity restrictions for one to two years after the operation.