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news item News Friday, June 28, 2019 Friday, June 28, 2019 12:44 PM - Friday, June 28, 2019 12:44 PM

Scoliosis awareness

What scoliosis is and how to identify signs

Scoliosis education never comes to an end at Shriners Hospitals for Children — Spokane. It is important to recognize the signs of scoliosis and understand the importance of seeking proper care. When it comes to pediatric scoliosis treatment, Shriners Hospitals for Children has the most amazing care anywhere!

What is scoliosis?

Scoliosis is one of the more common spinal disorders, in which the vertebrae rotate, causing an abnormal curve of the spine.Curves are often S-shaped or C-shaped. The most common type is idiopathic scoliosis, which means “cause is unknown,” but is thought to be genetic. Scoliosis can occur in otherwise perfectly healthy children. Because scoliosis may appear at any time during the growing years, it is essential that the spine be checked regularly by your doctor until growth is complete. The curvature may progress considerably during the rapid teenage growth spurt.

There are currently no medications to treat scoliosis, nor can its onset be prevented. The treatment prescribed for scoliosis varies with the individual patient. Treatment for scoliosis is based on the patient’s age, future growth potential, and the severity and location of the curve.

How can scoliosis be treated?

  • Observation: If the child’s curve measures less than 20 degrees, periodic observation to watch for signs of further progression is generally recommended. Our spine team will follow the patient’s curve progression and examine the patient every four to six months while they are growing.
  • Bracing: Most physicians recommend their patients be fitted for a brace to prevent a curve from worsening while the child is growing, and has an idiopathic curve greater than 20 degrees.

    As the child nears the end of their growing period, the specific indicators for bracing will depend upon how the curve affects the child's physical appearance, if the curve is getting worse and the size of the curve.

    There are several types of braces. The type of brace will depend on the patient’s age and severity of the curve. Braces can be custom made or created from a prefabricated mold. The braces are prescribed to prevent a curve from progressing and must be worn every day for the allotted time, until the child stops growing.

    Types of braces:

    • Milwaukee brace (also known as the cervico-thoraco-lumbo-sacral orthosis (CTLSO): This type of brace is used to correct any curve in the spine. It is a full torso brace that extends from the pelvis to the base of the skull. The brace is intended to minimize further progression. This is a custom-fitted brace that fits under clothes.
    • Boston brace (also known as a thoraco-lumbo-sacral orthosis (TLSO): This is a brace usually prescribed for curves in the lumbar or thoraco-lumbar section of the spine. It is an underarm brace, fitting under the arm, extending around the rib cage, lower back and hips. It is worn under clothes.
    • Providence brace: This brace is used at nighttime only, and it can be worn up to eight hours while the patient is sleeping.
    • Charleston brace: This brace is often recommended for lower back curves in the lumbar spine. It is a bending brace to “untwist” the spine and is worn only while sleeping.
  • Casting: This option is usually reserved for our youngest patients and used in place of bracing. Application of the casts requires special techniques and equipment developed for infantile forms of scoliosis. It is often used to delay or prevent the need for surgery.
  • Scoliosis specific exercises: This 3-D treatment approach, pioneered by Katharina Schroth, is a curve-specific and comprehensive conservative treatment program for children diagnosed with adolescent idiopathic scoliosis.
  • Surgery:
    • Fusion surgery: Fusion surgery is recommended to correct a curve or prevent it from getting worse. Fusion surgery involves attaching rods, hooks, wires or screws to the curve and small pieces of bone are placed over the spine. The bone pieces will grow together with the spinal bone, fusing it in the proper position. Children who are candidates for fusion surgery usually must meet the following requirements:
      • The child is still growing and at least 10 years old
      • The curve is greater than 45 degrees
      • The curve is getting worse
      • If the curve is greater than 50 degrees, the patient is done growing
    • Fusionless surgery options: At Shriners Hospitals for Children — Spokane, there are several fusionless options that can be used alone or in tandem with other treatments. These fusionless options include vertebral body stapling (VBS). VBS is spinal stapling for children who are continuing to grow and either cannot or do not wear a brace long-term. This procedure serves as an “internal brace” and can help with growth modulated curve correction.
    • Growing systems: Shriners Hospitals for Children — Spokane offers expandable devices that are used in growing children diagnosed with scoliosis and include:
      • Growing rods: Growing rods allow for continued and controlled spine growth. They require a surgical procedure through the back, where the rods are attached to the spine both above and below the curve, with hooks or screws. The child then returns every six months to have the rods lengthened to parallel their growth. Some rods are able to expand on their own, eliminating return trips to the operating room.
      • Hybrid growth rod: Similar to the titanium rib, the hybrid growth rod is attached to the child’s ribs at one end and vertebrae at the other end. The device is used to assist straighter spine growth.
      • Vertical expandable prosthetic titanium rib (VEPTR or titanium rib): This device is used for growing children who have a chest wall deformity, with or without a scoliosis diagnosis. It is a titanium rod curved to fit the back of the chest and spine and is designed to grow with the child, helping to correct spinal deformity and allow for the development of the chest and lungs.

If you have concerns or believe your child may have scoliosis, please see your physician and ask them about Shriners Hospitals for Children — Spokane. The Spokane Shriners Hospital has the region’s only fellowship-trained pediatric orthopaedic surgeons. The Spokane Shriners Hospital staff treats kids from Washington, Montana, Idaho, Alaska and Canada in a family-centered environment, regardless of the families’ ability to pay. If you would like more information about how to request an appointment, call 1-888-895-5951, or see our Appointments and Admissions page.