Scoliosis is a curvature of the spine that usually occurs during the growth spurt children experience just before the onset of puberty. On an X-ray, the spine of a person with scoliosis looks more like an "S" or a "C" than a straight line.

Dr. Hoernschemeyer

When your child has been diagnosed with scoliosis, you want the most experienced physicians and leading-edge treatments available. Children's Orthopaedic specialists at University of Missouri Children's Hospital are here to determine the best course of care for your child. Depending on your child’s situation, treatment may include observation, bracing or possibly surgery.

Scoliosis can range from mild to severe, with the most severe cases impairing proper lung function and causing back problems. Our doctors evaluate your child and develop a personalized treatment plan that works for your whole family. 

Scoliosis Symptoms

The symptoms may include:

  • Uneven shoulders
  • The appearance of a rib hump when the patient bends over
  • One shoulder blade more prominent than the other 
  • Appearance of a leg length discrepancy

Diagnosis

The evaluation involves a detailed history, examination and often X-rays to determine the Cobb angle of the curvature.

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 10-25 degree Cobb angle is considered mild, 25-40 indicates moderate and an angle of greater than 40 degrees is severe. 

scoliosis team

Scoliosis Treatment

Treatment of idiopathic scoliosis depends on magnitude of the curve, its progression and the skeletal maturity of the patient. A Cobb angle less than 25 degrees generally does not require specific treatment, however close frequent monitoring should occur if your child is skeletally immature.

Scoliosis Bracing is considered the first line of treatment in curves at about 25 degrees in a skeletally immature patient. Bracing has been shown effective in preventing curve progression with the ultimate goal to halt curve progression until growth is complete. Although bracing does not permanently reduce the extent of the curve there is a direct correlation in extent of brace wear and overall effectiveness. 

The Schroth Method is a physical therapy treatment that uses a 3D approach to address the spinal changes that have occurred in all directions. Physical therapy will teach you to be aware of and in control of your posture, supplement and aid the success of brace wear and storage muscular and postural symmetry. MU Health Care has Schroth-certified physical therapists that work closely with you to create a treatment plan that best meets your specific needs.

The Schroth Method has been shown to significantly benefit those with scoliosis with a 10-25 degrees curve and want to begin treatment but may not be appropriate for bracing, or those with curves greater than 25 degrees and want the best results from their brace wear. Patients are also eligible for Schroth therapy if they’ve undergone VBT surgery and want to continue scoliosis-specific strengthening.

Surgery is usually recommended for curvatures of more than 40 degrees. We offer posterior spinal fusion and the fusionless procedure known as vertebral body tethering.

Spinal fusion fuses two or more adjacent vertebrae so that they grow together and form a bone that is no longer curved. Rods, screws, hooks and/or wires are placed in the spine in order to achieve curvature correction. The spinal fusion surgery has a long-term record of safety and efficacy for treating significant scoliosis. A risk to the procedure is that fused vertebrae may lose mobility, which can limit some of the back's bending and twisting depending on the levels fused. Fusion of the thoracic spine helps maintain flexibility as most bending is done with the lumbar spine and hips. 

Vertebral body tethering is a new treatment option that is a minimally invasive surgical procedure that can markedly correct scoliosis at the time of surgery.

To compare the two procedures, click here. To see a step-by-step guide to scoliosis surgery, click here.

Scoliosis mentoring program

The scoliosis mentoring program at Children's Orthopaedics helps connect families of children and teens to provide support and share experiences. Read more about this exciting program.