Scoliosis

If your child has been diagnosed with scoliosis — or you’re concerned they may have it — our pediatric orthopaedic team offers expert evaluation and advanced treatment options.

Scoliosis is an abnormal curvature of the spine that usually appears during your child’s growth spurt at or around the time of puberty. On an X-ray, their spine may look like an “S” or a “C,” rather than a straight line.

Pediatric orthopaedic specialists at Children's Hospital are here to help you determine the best course of care. Depending on your child's situation, treatment may include observation, bracing or possibly surgery.

Signs and Types of Scoliosis

Here are some common signs you may notice if you or your child has scoliosis:

Uneven shoulders
A rib “hump” when bent over
One shoulder blade sticks out more than the other
One leg appears longer than the other

The most common form in children is idiopathic scoliosis, which means the cause is unknown. However, other types of scoliosis can occur in kids with genetic disorders or neuromuscular conditions like cerebral palsy.

How to See Our Scoliosis Specialists

Diagnosis involves a detailed history, examination and often X-rays to determine the spine's curvature, or Cobb angle.

The Cobb angle measures the area of the spine with the greatest tilt and determines the severity of your child's scoliosis and ultimately his or her treatment options. A Cobb angle of 10-25 degree is considered mild, 25-40 indicates moderate and an angle of greater than 45 degrees is severe.

Scoliosis Treatment

Our pediatric orthopedic surgeons provide expert diagnosis and treatment for scoliosis in children and teens. Families from across Missouri and beyond come to Children’s Hospital for spinal care. To schedule an appointment or request a second opinion, contact our team directly.

As part of MU Health Care, our orthopedic surgeons also offer care for adults with degenerative (adult-onset) scoliosis. This type of scoliosis is typically caused by age-related changes to spinal anatomy.

How We Diagnose Scoliosis

At your child’s first appointment, we’ll ask questions about their medical and family history. We will also perform an evaluation that includes a physical exam and X-rays to determine the spine’s curvature (Cobb angle).

The Cobb angle measures the area of the spine with the greatest tilt and determines the severity of scoliosis. Scoliosis can range from mild to severe:

10 to 25 degrees is mild scoliosis
25 to 40 degrees is moderate scoliosis
More than 45 degrees is severe scoliosis

If your child is diagnosed with scoliosis, we’ll discuss treatment options with you and answer any questions you may have.

How We Treat Scoliosis

A Cobb angle of less than 25 degrees (mild scoliosis) may only require frequent monitoring. In this case, we can schedule regular follow-up appointments if your child is “skeletally immature,” or still growing.

If your child has moderate or severe scoliosis, we offer a wide range of nonsurgical and surgical treatment options. Your child’s care team may include:

Pediatric orthopaedic surgeons: Treat all types of spinal curvatures in children.
Orthotists: Design back braces personalized to your child’s anatomy.
Physical therapists: Trained in Schroth Method exercises which is directed at maintaining strength and flexibility of the spine.
Nurse practitioners: Provide education, support and care coordination.

Our specialists at Children’s Hospital will work together to help you determine the best course of care.

Braces for Scoliosis

Bracing may be the first line of treatment if your child is still growing and has a curve of about 25 degrees. Braces can prevent curve progression until your child’s growth is complete.

Braces are personalized to your child’s measurements and can be designed with a pattern they can pick out themselves. When properly worn, bracing can be highly effective at preventing further progression in a growing child.

Depending on your child’s curve and skeletal maturity status, they may be at risk for progression of their scoliosis despite bracing. In this case, they might be a candidate for vertebral body tethering (VBT) surgery.

Braces may not be effective for curves greater than 45 degrees because these curves can get worse into adulthood, even when growth is completed. At MU Health Care, we offer surgical options including spinal fusion and fusionless surgery like VBT.

Schroth Method for Scoliosis

The Schroth Method is a specialized physical therapy (PT) treatment for scoliosis that can benefit:

Kids with 10- to 25-degree curves who want treatment but may not be a candidate for bracing
Children with curves greater than 25 degrees who want the best results from their brace wear
Kids who need scoliosis-specific strengthening after surgery

MU Health Care is one of only a few centers in Missouri with Schroth-certified PTs. Using a 3D treatment approach, our PTs address spinal changes that have occurred in all directions. This therapy can help your child become more aware of and in control of their posture.

Spinal Fusion

Spinal fusion connects two or more adjacent vertebrae so they grow together and form bone that is no longer able to curve. We place rods, screws, hooks or bands to correct the curve.

This surgery has a long track record as an effective treatment for severe scoliosis. One risk is that fused vertebrae lose mobility, which can limit some bending and twisting of the back. However, this is less likely to be an issue with fusions of the thoracic spine (upper back), as most bending is done with the lumbar spine and hips.

We also offer the latest “growth-friendly” fusion surgeries that correct scoliosis while your child grows, including:

VerteGlide (Shilla technique): Uses implants that can lengthen as the spine grows.
Magnetic expansion control (MAGEC): Uses a magnetically controlled system to lengthen rods from outside your child’s body.

Fusionless Surgery

VBT is a minimally invasive procedure that can significantly correct scoliosis and eliminate the need for spinal fusion surgery. Compared to fusion, it is less likely to limit your child’s range of motion and flexibility.

Scoliosis Mentoring Program

The pediatric orthopaedic scoliosis mentoring program helps connect families so they can share experiences about having scoliosis surgery. Before your child’s surgery, we’ll put you in touch with a postsurgical patient who has agreed to be a mentor. You and your child can ask questions and learn about the benefits of scoliosis surgery.