Scoliosis is a rotational deformity of the spine often presenting due to prominence of the ribs or different shoulder heights. The most common type of scoliosis is idiopathic, meaning that there is no known cause, but it can also be caused by an underlying condition. It is typically asymptomatic, and children with scoliosis are often first diagnosed by their parents or a teacher who notices the prominence of the ribs, unequal shoulder heights, or curve in the spine.
Once diagnosed with idiopathic scoliosis, it is important to monitor the child with serial xrays so that if required, treatment can be offered to prevent worsening of the scoliosis curve. During periods of rapid growth the curve can progress rapidly, and this is a time where more frequent monitoring may be recommended.
Treatment may be offered for children with a curve angle (Cobb) of more than 20 degrees particularly if they have a long growth period left, or for a curve that has shown to be progressing. This is in the form of a custom moulded brace that aims to prevent worsening of the curve angle if worn correctly. The aim of treatment is to maintain the curve at an angle below 30 degrees at skeletal maturity, as long term studies have shown that curves less than 30 degrees don’t tend to worsen after skeletal maturity, whereas those curves more than 50 degrees progress at around 1-1.5 degrees per year.
For curves over 50 degrees surgery may be offered. There are different options for different curve types and locations, but the aim is to restore a balanced spine and correct the curve as well as rotation as much as possible. This can be done with a posterior spinal fusion, anterior spinal fusion, or a combination of anterior and posterior. There are also options for vertebral body tethering which relies on predictive growth to correct the curve slowly over time.