“Bend down and touch your toes.” When the pediatrician asks your child to do this at each well visit, it provides important clues about the development of their spine. If the spine has a side-to-side curve it may be a sign of scoliosis.

The causes and signs of scoliosis

Nearly 3 million kids are diagnosed with scoliosis each year. Idiopathic scoliosis is the most common type, often appearing around puberty and during times of rapid growth. The cause, though, remains unknown in most cases.

“Parents will often ask if their child has developed scoliosis because of poor posture or the heavy backpack they lug around every day,” said Dr. Chester Sharps, orthopaedic surgeon. “These things can definitely cause back pain, but they don’t lead to scoliosis. It’s more likely that scoliosis runs in the family, though you may not even be aware any relatives have it.”

Many times, scoliosis is so mild it goes undetected, or it’s only noticed during a check-up when the pediatrician is specifically looking for it. In other cases, you may notice some signs of scoliosis at home:

• Shoulders and/or hips appear to be at different heights
• Arms appear to be different lengths
• One side of the ribs pushes out
• One shoulder blade sticks out farther than the other
• Head doesn’t appear centered over the body
• Leaning to one side

It’s worth mentioning any of these symptoms to the pediatrician so they can keep an eye on it. If there’s a concern of scoliosis, the doctor may recommend x-rays to take a closer look. The EOS x-ray imaging tool is ideal for this because it provides crystal-clear images with two to three times less radiation than conventional x-rays. It also takes images of the child while standing to best assess their spine in a typical weight-bearing position. The only EOS machine in Richmond is located at our Children’s Pavilion.

Treating scoliosis in kids and teens

Most cases of scoliosis need only close observation or bracing to help support the spine and guide it into a straight position as it grows. About 10% of the time surgery is the best option.

“Scoliosis care is state of the art at CHoR. Our orthopaedic surgery team uses a variety of techniques, instrumentation systems and computer navigation,” said Dr. Sharps. “Plus, we can provide a thorough examination and EOS imaging all in one visit.”

Fusionless surgery (tethering) for progressive scoliosis

In the case of progressive scoliosis in young kids, a new treatment called fusionless surgery (tethering) can be effective. It’s done by inserting screws along the outer edge of the curvature and threading a strong, flexible cord (tether) through them that can be tightened to straighten the spine as it grows. This approach involves only a few small incisions and still allows the spine to bend and move.

Determining the best scoliosis treatment for your child

Fusionless surgery isn’t appropriate for everyone or for all types of scoliosis. Spinal fusion surgery is often used in older kids and teens and for more severe scoliosis (curvature of 45 degrees or more and when bracing is not effective). In this procedure, metal rods are inserted to straighten and solidify the spine, so it won’t curve in the future. The spine fuses over a period of several months.

Our surgeons also use self-lengthening rods (MAGEC rods) in some young children. The rods can be lengthened magnetically in the office every few months as the child grows, without the need for additional surgeries. 

The best treatment will depend on several factors, including the severity of the curve, how quickly it’s progressing and how long your child will continue growing. The important thing is to stay on top of it and work with a doctor to get the right care at the right time.

Learn more about all the expert pediatric orthopaedic care at CHoR.