Adolescent Idiopathic Scoliosis (Ages 10 to 18)

What are the signs and symptoms of idiopathic scoliosis?

Scoliosis is not painful for most children. However, there are other signs that a child has idiopathic scoliosis, including:

• Imbalanced or uneven shoulders
• Uneven waist appearance
• Prominent shoulder blades

What tests are used to diagnose idiopathic scoliosis?

Your child’s doctor diagnoses scoliosis by performing a physical exam of the back. The doctor has your child bend forward to check for an uneven spine or ribs that stick out more when your child bends forward.

After this simple exam, the doctor usually reviews X-rays of the entire spine, from both the back and the side.

Why should you bring your child to Children's Colorado for scoliosis testing?

Children's Colorado Spine Program is the only pediatric spine program in our multistate region with the EOS imaging system for scoliosis. This imaging offers many benefits:

• EOS reduces a child's radiation exposure up to nine times compared with regular X-rays.
• The image quality is better than regular X-rays.
• EOS images can be gathered faster than regular X-rays.
• There is no extra cost when using EOS imaging compared to regular X-rays.

How is idiopathic scoliosis treated?

Our spine specialists provide individualized treatment for scoliosis. We consider factors including your child’s age, activities and other medical conditions, and the severity of the scoliosis. Depending on the size of the curve and age of your child, treatments can include:

• Monitoring in the clinic with examination and low-dose EOS imaging
• Wearing a brace
• Completing scoliosis-specific exercises
• Surgical treatment
• Vertebral body tethering, which helps guide spine growth and maintain mobility

Learn more about vertebral body tethering and how it helped Josiah:

Many children with idiopathic scoliosis need regular monitoring of their spinal curvature with an exam and X-rays 1 to 2 times per year. Our spine specialists may recommend scoliosis-specific exercises and brace treatment for some children, and in serious cases, they may recommend surgery.

Why choose us for the treatment of your child's idiopathic scoliosis?

The Spine Program at Children's Colorado is among the most knowledgeable pediatric spine care teams in the country. Our experienced team cares for infants, children, adolescents and young adults. We diagnose and treat all types of spinal conditions and injuries, ranging from scoliosis to complex neuromuscular disease and trauma. More kids with idiopathic scoliosis get treated at our Spine Program than anywhere else in Colorado.

We are involved in advanced research and innovation in spine care for children and adolescents. Our team has published over 100 articles in the leading orthopedic and spine surgery journals and routinely speak at international conferences and courses for other surgeons.

The Spine Program has received research grants from the National Institutes of Health, Scoliosis Research Society and Pediatric Orthopedic Society of North America. Learn how we're advancing scoliosis treatment through our orthopedics research.

From the most basic to the most complex spinal conditions, our goal is to always provide the safest, most effective treatments, often beginning with non-surgical options. If your child needs surgery, we offer innovative approaches from experienced surgeons. Learn why we have some of the best spine surgery outcomes in the country.

Who should do scoliosis exercises?

Children with scoliosis who have years of growth remaining may be candidates for brace treatment and scoliosis-specific exercises. These treatments can reduce the risk of the curve increasing, and scoliosis-specific exercises can relieve discomfort caused by scoliosis.

Frequently asked questions about scoliosis-specific exercises (SSE)

What is an SSE program?

Standard features of our SSE program include 3D self-correction, training activities with activities of daily living (ADLs) and stabilization of a corrected posture. This approach was accepted by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in 2011.

In the video below, our physical therapist Michelle Kohl explains how spine exercises can help some patients improve their spine curvature.

What are the goals of SSE?

The goals of physical therapy (PT) and SSE are:

• Improve flexibility and strength in key muscle groups
• Increase posture awareness by understanding (at an age-appropriate level) the mechanics of the spine and the individual curve type
• Perform the exercises in the best possible spinal alignment
• Improve comfort of brace wear
• Address any muscular back pain that may be present

Where is SSE offered?

We offer SSE at these locations:

• Health Pavilion, Aurora
• Urgent and Outpatient Specialty Care at Briargate, Colorado Springs

What can we expect from the SSE program?

We’ll evaluate your child and then schedule 4 to 5 follow-up visits to team them the foundational exercises. Visits are typically one hour.

Your child will do the exercises at home and continue to see their spine doctor as needed. They may need to return to physical therapy to adjust the exercises based on any changes in their spinal curve pattern.

Who is appropriate for SSE, and how are they referred for SSE?

Our providers screen children with adolescent idiopathic scoliosis to decide whether to refer them to physical therapy. Referral criteria include:

• Diagnosis of adolescent idiopathic scoliosis (without neuromuscular or other causes of scoliosis)
• Spine curvature between 10 to 50 degrees
• Willingness and ability to participate in a home exercise program 20 to 30 minutes, five days a week

Can patients who have had posterior spinal fusion surgery do SSE?

Outpatient PT is not routinely needed after spine fusion surgery. However, some factors are considered on a case-by-case basis in a discussion between the child, parents and the orthopedic physician team. Your child may benefit from SSE if they:

• Have specific goals or need to improve core strength
• Need to learn proper spine and trunk alignment after surgery
• Need to work on spine alignment and strengthening for activities related to sports participation

Bracing for idiopathic scoliosis

The goal of bracing is to stop your scoliosis curve from increasing as you grow. Bracing is a nonsurgical scoliosis treatment for children who:

• Have been diagnosed with idiopathic scoliosis
• Are still growing
• Have spinal curves between 20 and 40 degrees

Our specialists most often recommend a thoraco-lumbar-sacral orthosis (TLSO) brace for children with scoliosis. In some cases of primary curves in the lumbar spine (lower spine), we may also consider using a nighttime-only brace.

Frequently asked question about bracing for idiopathic scoliosis

Why do I need to wear a brace?

Bracing can reduce the risk of your scoliosis curve increasing. A study published in the New England Journal of Medicine showed that wearing a brace properly reduces the risk of curve progression by about 50%.

There is no guarantee that bracing will completely stop your scoliosis curve from increasing, but it helps in most cases. We understand that not knowing if bracing will work is challenging for you and your family. What we do know is that following your doctor’s treatment plan is the key to improving your situation as much as possible.

How many hours a day do I have to wear my brace?

Research shows that the more you wear the brace, the more effective it will be at preventing scoliosis from getting worse:

• Less than 12 hours a day = no benefit
• 12 to 16 hours a day = potential to stop the curve from getting bigger
• 16 to 23 hours a day = maximum benefit

Your orthotist (the professional who makes the brace) applies a monitor in your brace. It has small thermal (heat) sensors that record the internal temperature of the brace.

The sensors provide valuable information that help you and your doctor see your wear time and patterns. They don’t track where you go or what you do. They only measure temperature in the brace, which corresponds to wearing or not wearing the brace.

When can I stop wearing the brace?

You'll wear your brace until most of your growth is done, or if your curve keeps increasing even after wearing the brace. Your doctor will talk with you about how long you can expect to wear your brace.

What if the brace is uncomfortable?

It may take some time to get used to wearing your brace. Movements like bending down and sitting on the floor will feel different at first. Don't worry — you’ll adjust to these changes.

Your orthotist will give you instructions on gradually getting used to the brace. Contact the orthotist if you notice any areas of concern, such as redness or tightening in an area. We may need to adjust the brace in between check-ups with your provider.

Can I still participate in activities and sports?

Yes. It's important to continue sports and physical activities, which improve your overall health and well-being. You can take off your brace during exercise. Taking off your brace allows the muscles in your core to get stronger.

Core muscles are the muscles that surround your back, abdomen, pelvis and hips. The core is the body's center of strength.

Having good core strength decreases the workload and stress on your lower back. Your exercise program should involve stretching and strengthening these muscles. Watch our core exercise videos to learn 12 exercises for strengthening your back.

It's ok to take your brace off during:

• Exercise
• Sports
• Dance
• Showering and bathing
• Physical education class
• Special occasions determined by you and your family

Will everybody know that I'm wearing a brace?

Braces are low profile and accommodate active lifestyles. They aren't as noticeable as you might think. There may be times when friends or people around you notice the brace, like when you change for PE class, for example. If they do notice your brace, just remember that they are curious, and a brace is nothing to be embarrassed about.

If you wear a loose-fitting shirt, it's often hard to see the brace. We recommend wearing a shirt under the brace that wicks moisture away. Use a shirt made from a high-performance material usually found at sporting goods stores, or even a tight-fitting cotton T-shirt to absorb moisture. The shirt should be seamless to prevent wrinkling and discomfort.

When is surgery recommended for adolescent idiopathic scoliosis?

Scoliosis is often recommended for adolescents with idiopathic scoliosis that exceeds 40 to 45 degrees. Scoliosis surgery can reduce the curvature significantly, while also improving:

• Shoulder imbalance
• Shoulder blade prominence
• Rib hump
• Waist balance
• Self-image
• Pain

What happens if a patient with scoliosis doesn't have surgery for a large curvature?

Progressive scoliosis in adults has been shown to lead to increased back pain and unhappiness with appearance. As the curve increases past 70 degrees, it may affect lung function, but usually not enough to require treatment.

People with scoliosis that gets much worse (exceeding 90 to 100 degrees) can have serious problems with lung function that increases the risk of:

• Pneumonia
• Need for supplemental oxygen
• Restrictions on activities due to shortness of breath

What to expect from scoliosis surgery

The goals of surgical treatment are to prevent the curve from worsening and to safely straighten the spinal curve. Surgery generally includes placing screws and rods into the spine to correct the curve. The rods hold the spine in the corrected position and allow the bone to fuse.

We plan surgeries based on current research and use the most advanced technology. The type of surgery we perform is based on the child’s age, as well as the type and severity of scoliosis and any underlying medical conditions.

How long is scoliosis surgery?

The length of scoliosis surgery varies, but most are 2.5 to 3.5 hours of surgical time. Total time is typically 5 to 6 hours including anesthesia, setup, positioning and wakeup.

Our surgical approach involves:

• Pediatric experts including orthopedic surgeons, anesthesiologists, physical therapists, social workers, nutritionists, respiratory therapists and child life specialists
• Highly specialized nursing staff with pediatric orthopedic training
• A welcome program coordinator who introduces your family to Children's Colorado and provides supportive services
• Robotic assistance and 3D navigation for increased accuracy and safety
• Operating rooms and equipment designed just for kids, teens and young adults
• State-of-the-art spinal cord monitoring
• Blood conservation techniques
• Multidisciplinary infection prevention practices
• Several modes of pain management and control

Learn how robotic surgery helped Katie get back to her life:

Learn more about spine surgery and spine class at Children's Colorado.

Watch this video to learn more about scoliosis surgery:

Mire este video para aprender más información acerca de la cirugía para la escoliosis.