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Scoliosis, or curvature of the spine, affects about two percent of the population and usually occurs for unknown reasons. Most often, it develops in late childhood, before puberty, in otherwise healthy children. The condition occurs in girls more often than boys. In adults, scoliosis usually represents a condition that actually began in childhood but was discovered later; or it can be caused by degenerative changes in the spine.

Scoliosis usually goes unnoticed in childhood, because it rarely causes symptoms. Treatment is essential in order to prevent more serious problems and progression of the curvature. Anthony F. Guanciale, M.D., assistant professor and director of spine surgery at the University of Cincinnati Medical Center and orthopedic surgeon at The University Hospital recommends observing children for signs of scoliosis starting when they’re 8 - 10 years of age and bringing any of the following signs and symptoms to the attention of your doctor:

• Uneven shoulders
• Prominent shoulder blade or shoulder blades
• Uneven waist
• Elevated hips
• Leaning to one side
• Persistent low back pain

If your child is diagnosed with scoliosis, an orthopedic specialist will consider a number of factors in deciding on treatment. 

Especially important is the severity of the curve, which is measured in terms of degrees of curvature. Most curvatures are minor and need only to be watched for signs of progression. If they do progress, an orthopaedic brace can be worn (under clothing) to prevent it from getting worse. Dr. Guanciale explained, "It is important to keep in mind that a brace doesn’t correct the curve but only attempts to reduce progression of the curve." Children who wear these braces can continue to participate in physical and social activities. Electrical muscle stimulation, exercise programs, and spinal manipulation have not been found to be successful in treating scoliosis, according to the American Academy of Orthopaedic Surgeons.

If the curve is severe (exceeding 50 degrees or, in growing children, 40 degrees) or if treatment with a brace does not control it, surgery may be necessary. This is a highly effective and safe treatment, although it is a fairly extreme measure and will not be recommended unless it’s the only way to correct the curvature.

The goal of surgery is to straighten the spine as much as possible, to balance the torso and pelvic areas, and to maintain this correction. This is accomplished by fusing, or joining together, the vertebrae along the spinal curve and supporting the fused bones with a steel rod and other instrumentation attached to the spine.

It takes about three months for the bones to fuse, during which time the child remains in a full-sized brace. Healing is not considered complete for one to two years. After that time, the steel rod that was implanted in the spinal area is not necessary, but is usually left in place unless an infection or other complication occurs. The fusion actually stops the growth of the spine and, therefore, halts progression of the curve. This surgery is often not done until most of a person’s adolescent growth has occurred. During this time, a person is often maintained in a brace.

An orthopedic spine surgeon or pediatric orthopedic surgeon is the most knowledgeable and qualified physician to diagnose, monitor, and treat this condition.

SOURCE: The American Academy of Orthopaedic Surgeons, WebMD  and Anthony F. Guanciale, M.D., orthopedic surgeon at The University Hospital and assistant professor and director of spine surgery in the orthopeadic surgery department of the University of Cincinnati Medical Center.