How is Scoliosis in Children and Teenagers Diagnosed?
The typical scoliosis screening age is 10, with your pediatrician checking your child’s back curve at annual well-child visits throughout the preteen and teen years. If your doctor notices a curve and recommends a consultation with a pediatric spine specialist, the Och Spine at NewYork-Presbyterian pediatric spine team offers all of the exams and tests needed in order to diagnose your child correctly.
When you come to us, we may take several steps to confirm your child has scoliosis and identify its type and severity, whether mild or severe. Steps may include:
- Medical history assessment to learn about your child’s symptoms
- Physical exam to assess your child’s range of motion, gait (the way your child walks), sensation, reflexes, spine shape, hips, and shoulders
- Imaging exams, such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI), help show the bones, discs, and nerves in and around the spine.
- Innovative 3D and 4D computerized imaging technology to analyze posture and gait
Mild vs. severe scoliosis
The Cobb angle is the most accepted method of measuring scoliosis. This measurement is taken on X-ray, measuring the spine’s curve. Mild scoliosis is defined as scoliosis where the curve is less than 25 degrees. Severe scoliosis is defined as a curve above 40 degrees. The curve’s severity may also affect the course of treatment and whether a child may need surgical intervention or now.
How is Scoliosis in Children and Teens Treated?
Scoliosis treatment for children and teens varies depending on the severity of the condition and curve of the spine. Children with mild curves will need regular check-ups to monitor the condition but typically don’t need treatment. Nonsurgical and surgical treatments are available if the condition progresses to more moderate or severe scoliosis.
Nonsurgical scoliosis treatment for children and adolescents
Whenever possible, the pediatric spine orthopedic surgeons and neurosurgeons at Och Spine try to treat your child conservatively, meaning no surgery is required.
Treatments for scoliosis in children include:
- Observation is an option for children with mild scoliosis. Your doctor will want to monitor your child for signs of scoliosis to determine if the condition is getting worse, better, or staying the same. Some children with very mild scoliosis may not need any treatment if the condition does not worsen as they grow up. NewYork-Presbyterian has the EOS low-dose x-ray system, which enables us to take repeated scans to monitor scoliosis progression in young patients while keeping radiation exposure to a minimum.
- Physical therapy is widely used for many children with spine conditions, including scoliosis. It is also an important part of care after pediatric scoliosis surgery. Physical therapists teach ways to improve strength, posture, and flexibility. Your child will learn exercises to do with the therapist and at home to stabilize the spine, correct body mechanics, strengthen the core, improve posture, and stretch tight muscles.
- We offer Schroth physical therapy at our Center for Conservative Treatment of Scoliosis. The goal of the Schroth method for scoliosis is to optimize the health of each patient’s spine and movement system throughout the lifespan.
- Through specific exercises and corrective breathing techniques, the therapist aims to elongate the child’s trunk and correct imbalances in the body. This therapy optimizes posture and alignment in the upper trunk to correct spinal abnormalities by facilitating muscle balance.
- The result is decreased pain, slowing or halting the curve’s progression, and better heart and lung function, mobility, and posture. Many adolescents with idiopathic scoliosis benefit from starting treatment with Schroth physical therapy.
- Rigo Cheneau bracing is a lightweight plastic vest custom-made for each child. It is a corrective brace for scoliosis in children that is worn for 12-20 hours a day. Children often wear the brace into their teens until they stop growing. If the brace is not correcting the curve, your surgeon may recommend an operation. Children with neuromuscular scoliosis may also benefit from a brace until they are ready to have scoliosis surgery.
- Mehta casting is a treatment for infantile scoliosis (children under age 3) that involves the customized placement of a fiberglass cast every eight weeks, with correction of the curve typically achieved by 18 months. After that, your child may need a brace for two to three years to maintain the correction.
Surgery for scoliosis in children and teens
When nonsurgical treatment for scoliosis in adolescents and children isn’t effective, you can rest assured that Och Spine’s pediatric orthopedic spine surgeons and pediatric spine neurosurgeons are well prepared for any surgical intervention.
Our team performs procedures with advanced monitoring and computer navigation to ensure your child’s safety during the procedure and to guide the precise placement of rods, hooks, and screws when needed.
Our team specializes in the following procedures:
- Anterior vertebral body tether (AVBT) is a new approach for idiopathic scoliosis. The traditional surgery for scoliosis—posterior spinal fusion and instrumentation (PSIF)—uses a rod placed in the back of the spine. During AVBT, a newer approach procedure, doctors place a flexible cord from the front part of the spine only along the convexity of the curve. This allows for the correction of scoliosis but also continued growth on the opposite (concave) untethered side of the curve.
- Growing rods can be inserted to correct scoliosis without fusing the spine. This will minimize any stunting of growth that can occur with spinal fusion. The most commonly used types of growing rods include:
- Traditional growing rods are anchored at the top and bottom of the spine and are periodically lengthened in a simple procedure as the child grows.
- Vertical expandable prosthetic titanium rib (VEPTR) is attached to the ribs at the top of the device and the spine or hips at the bottom. It is useful for infants and children with scoliosis and breathing problems.
- MAGEC® (MAGnetic Expansion Control) Growing Rods treatment involves the surgical placement of special growing rods in a young child’s spine. The surgeon adjusts the rods every few months using a remote-controlled device applied to the outside of the child’s back during a routine outpatient visit, sparing the need for repeated surgeries. NewYork Presbyterian Hospital was the first hospital in New York City to offer MAGEC growing rods.
- Spinal fusion using various forms of spinal instrumentation is the most common treatment used in children whose curvature cannot be corrected with other means. During this procedure, the vertebrae are placed into a more normal three-dimensional alignment to correct the curve using various spinal implants, then fused together with bone grafts to ensure long-term success. This remains the most common treatment for most adolescent patients with various spinal conditions such as scoliosis, kyphosis, and spondylolisthesis.
Advanced Pediatric Scoliosis Care at Och Spine at NewYork-Presbyterian
Pediatric spine conditions can be challenging to manage. Doctors need to carefully consider the effects of treatment on a child’s growth while taking into account the need to relieve discomfort, restore function, and improve strength and mobility.
The pediatric scoliosis professionals at Och Spine are renowned experts in the field. Our pediatric spine surgeons have led various national organizations and research groups committed to improving the quality and safety of pediatric spine care and developing more effective treatments.
When you bring your child to us for care, you will benefit from specialists who have helped develop the standards for pediatric spine care used across the country and around the globe.