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5 Common Types of Scoliosis: Which Form Does Your Child Have?

5 Common Types of Scoliosis: Which Form Does Your Child Have?

by | Dec 3, 2023 | Scoliosis & Spine

Scoliosis is a common orthopedic condition that affects between 2% to 3% of the population. This abnormal sideways curvature of the spine can range from mild to severe, with varying health impacts. Scoliosis must be monitored until children stop growing, and moderate to severe curves will need corrective treatment. However, different types of scoliosis have different prognoses and may require different types of treatment.

What Is Scoliosis?

Prior to learning about the different forms of scoliosis, it helps to first understand what this condition is and how any form of the disease can affect a child.

Scoliosis happens when a child’s spine curves sideways. Normally, the spine is straight or has a slight S-curve when you look at it from the side — the top of a child’s back may curve out a little bit, and their lower back may curve in slightly.

In children with scoliosis, the spine curves or twists in an S- or C-shape. Mild cases may only limit a child’s flexibility, but severe cases can cause deformities and serious health problems, such as:

  • Arthritis
  • Back pain
  • Breathing problems or other lung issues
  • Heart problems
  • Paralysis
  • Problems walking, standing or doing other physical activities

Whether mild or severe, the form of scoliosis your child has can also play a role in its long-term impacts. Below are five common types of scoliosis.

Idiopathic Scoliosis

Idiopathic scoliosis, also called adolescent idiopathic scoliosis, is the most common type of scoliosis, affecting around 80% of children with scoliosis. It typically shows up at age 10 or later and has no known cause, although there is a genetic connection. About 30% of children with idiopathic scoliosis have a family history of scoliosis.

Despite what many parents or kids may think, carrying a heavy backpack or slouching will not cause scoliosis.
Treatment for this type of scoliosis depends on the severity of your child’s spinal curve, defined as:

  • Mild, less than 20 degrees
  • Moderate, between 25 degrees and 40 degrees
  • Severe, greater than 50 degrees

Regardless of severity, many children with scoliosis benefit from physical therapy (PT). PT helps reduce pain and improve breathing, while also preventing a curve from getting worse.

Children with mild curves may simply need monitoring every six to 12 months to ensure a curve is not getting worse.

Moderate curves may require a child to wear an orthotic back brace daily for months or even years. Braces are usually successful in stopping the curve from progressing to a point of needing surgery.

Severe curves or moderate curves that do not get better with bracing may require spinal surgery. Spinal fusion is the most common type of surgery for severe adolescent idiopathic scoliosis, but some patients may benefit from a newer technique, vertebral body tethering (VBT).

Congenital Scoliosis

Congenital scoliosis is a form of the condition that exists when a child is born. A rare birth defect, congenital scoliosis occurs in only 1 in 10,000 children.

There are several different types of congenital scoliosis, each affecting how the spine curves abnormally in different ways. All can cause serious problems in children’s growth.

Many children with congenital scoliosis are not diagnosed until the problem becomes noticeable later in childhood or during the teenage years.

Unlike idiopathic scoliosis, congenital scoliosis usually cannot be helped by bracing. Children with mild curves will still likely only need monitoring, but those with moderate to severe curves may need surgery.

Neuromuscular Scoliosis

Neuromuscular scoliosis is caused by medical conditions that impact the muscular or neurological systems. These conditions can affect a child’s muscle balance or how the body controls the muscles that support the spine.
Common neuromuscular conditions that lead to scoliosis include:

  • Cerebral palsy
  • Friedreich ataxia
  • Muscular dystrophy, especially Duchenne
  • Myelodysplasia
  • Spina bifida
  • Spinal muscle atrophy
  • Spinal trauma, especially that causing paralysis

These conditions may require children with scoliosis to be in wheelchairs. For those children, wheelchair seats can be modified to improve balance.

Bracing may also help many patients with neuromuscular scoliosis, but it will not stop the progression of curves. Surgery may be an option, depending on the underlying medical condition and other factors.

Early-Onset Scoliosis

Early-onset scoliosis develops before age 10. In most cases, early-onset scoliosis is idiopathic. Treatment is crucial for preventing breathing problems or deformities later in life.

Infants and children younger than age 2 who have early-onset scoliosis may need to wear a cast for two to three months at a time. In children this young, casting is often easier than bracing.

If a very young child’s scoliosis is severe, they may need a special type of surgery that involves attaching a magnetic rod to the spine. The rod can be lengthened as the child gets older, at which point they usually have spinal fusion surgery.

Syndromic Scoliosis

This type of scoliosis is very rare and develops as part of another condition, such as:

  • A connective tissue disorder, such as Marfan or Ehlers-Danlos syndrome
  • Beale’s syndrome
  • Down syndrome
  • Prader-Willi syndrome
  • Rett syndrome

Treatment options for syndromic scoliosis depend on the severity and the other health conditions involved.

Could Your Child Have Scoliosis?

Children are usually screened for scoliosis during their annual wellness exams, and they may be screened at other times, such as during school health screenings.

However, children grow quickly, so it’s important for parents to know the symptoms of scoliosis. Be on the lookout for signs such as:

  • Back pain
  • One shoulder blade that sticks out more than the other
  • One shoulder, hip bone or rib cage that seems higher than the other
  • Rounded shoulders
  • The sense that your child’s head is no longer directly centered above the pelvis
  • A sunken chest

Call your child’s pediatrician if your child experiences any of these symptoms or if you notice an unusual spinal curve when your child bends forward to touch their toes. Getting treatment early, no matter which type of scoliosis your child has, often leads to more successful outcomes.

If your child has been diagnosed with scoliosis, the Scottish Rite Center for Excellence in Spine is here to help. Schedule an appointment to discuss scoliosis care.

Get to Know our Staff: Courtney Warren, Physical Therapy

Get to Know our Staff: Courtney Warren, Physical Therapy

by | Jun 22, 2020 | Spotlight

What is your role at Scottish Rite for Children? 
I am an outpatient physical therapist in the Orthopedic department at the Frisco campus. I evaluate and treat children and adolescents with musculoskeletal, neurologic and rheumatologic conditions through specialized exercises, activities and other techniques. I work with many specific populations including patients with scoliosis, amputations, birth defects and acquired injuries. My goal is to figure out physical barriers that may keep a child from their goals and then design treatment to improve or adapt those barriers in order to achieve their highest level of function.   
 
What do you enjoy most about Scottish Rite?
I enjoy working with the large variety of patients that Scottish Rite treats. This includes a wide spectrum of age, level of function and even nationalities. People come from all over to be treated here. 
 
I also really enjoy the fact that the staff are here to do what is best for the patients and everyone works hard to make sure finances or other barriers do not restrict treatment. 
 
What was your first job? What path did you take to get here?
My first official job was working at a grocery store when I was a teenager. I had odd jobs all throughout high school and college. My path to becoming an employee at Scottish Rite is kind of interesting. My mother began working as a surgical nurse in Dallas when I was just 3 years old, so I grew up attending holiday parties and staff picnics. I eventually became a junior volunteer, a shadow student and then completed my final clinical rotation for physical therapy school – all at Scottish Rite. It was my first job out of school, and I have been here six years now. 
 
I can actually remember the exact day and specific patient I was observing at Scottish Rite when I decided I wanted to be a physical therapist. I was 14 years old and I never changed my mind! 
What’s the coolest or most interesting thing you’re working on right now?
I completed my first level certification in the BSPTS Schroth based method for the treatment of adolescent idiopathic scoliosis in 2018 and I was planning to attend/test for the second level certification this summer. That was put on hold with the current events, but I’m hoping to complete it soon. 
 

What are you currently watching on Netflix/Hulu/TV/etc.? 
In our home, Daniel Tiger or Sesame Street is usually playing (I have a 2-year-old), but I recently started watching The Amazing Race series and have enjoyed seeing the world travels, even just by TV screen. 
 
What would be the most amazing adventure to go on?
When I was younger, I always wanted to run a race on every continent. So far, I have done two – North America and Europe. I would love to check off more! 
 
What are some small things that make your day better?
At work, I really enjoying watching a child reach a goal or come back for a social visit when they have been discharged for a while. Seeing/hearing children doing what they love is the best!
 
At home, there is nothing better than my son running up to hug me and tell me about his day when I get home. 
 
What is special about the place you grew up?
I grew up in Wylie, Texas. We have a bit of an unusual motto, “AHMO”, that originated from a Dean Martin comedy roast. It means a lot of different things to different people and can be found literally all over the town. 
 
What is your favorite thing to do when you’re not working? 
I can be found doing lots of things to stay active. Running, playing soccer and keeping up with my son are just a few of my favorite things!
Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis

by | Jun 18, 2018 | Scoliosis & Spine

Article originally published by staff orthopedist Amy L. McIntosh, M.D., in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 
What is scoliosis?
Scoliosis is a rotation in the spinal column that creates a “C”-shaped single curve or an “S”-shaped double curve, when viewed from behind (Figure 1). Some cases worsen with time and can result in serious problems such as abnormal appearance in posture, increasing back pain as one ages, and in the worst cases, interference with heart and lung function. Idiopathic (no underlying cause) scoliosis occurs in 2 to 3% of the adolescent population, usually affecting young people between the ages of 10 to 16. Scoliosis onset is usually earlier in girls than in boys—generally, ages 10 to 14 for girls and 12 to 16 for boys.


Figure 1

When should I screen patients for adolescent idiopathic scoliosis (AIS)?
Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Screening can detect scoliosis at an early stage, when the curve is mild. Most curves can be treated without surgery if detected before becoming too severe. Therefore, early detection is the key to controlling spinal deformities. Ideally, spinal screening should be conducted as a part of the annual examination for females at age 10 and 12 years, and males once at age 13 or 14 years. Signs to watch for include (see Figure 2):

  • One shoulder higher than the other. One shoulder blade higher or more prominent than the other
  • One hip higher than the other.
  • Space between arms and body greater on one side.
  • Leaning to one side.
  • Head not centered directly above the pelvis.
  • When bending forward, thoracic rib prominence or lumbar fullness that is asymmetric to the opposite side. (+ Adams forward bend test) (Figure 3)​

If any of these signs are present, then the child should be referred to a pediatric orthopedic surgeon. Texas Scottish Rite Hospital for Children has a low dose X-ray machine (EOS) that obtains high quality images with significantly less radiation exposure to the patient. For that reason, please do not obtain X-rays. Just refer the patient if clinical signs of scoliosis are apparent on physical exam. The orthopedic surgeon will obtain standing, full length (posterior-anterior and lateral) spine X-rays to measure the cobb angle in both the frontal and sagittal planes. The Cobb angle measurement and the skeletal maturity of the child will determine the treatment.
What are the treatment options for AIS?
Observation:
Routine rescreening or observation by the physician is a form of treatment for mild curves (11-20 degrees). This observation period consists of regular clinical exams and spine X-rays throughout the rapid growth years of adolescence until the spine is mature. It is important to note that more than 90 percent of patients with scoliosis require no treatment other than observation. 

Brace: 
For curves greater than 20 degrees in patients that are still growing rapidly, a brace is prescribed. The brace can prevent the curve from progressing and may eliminate the need for spinal surgery. However, the brace cannot correct the curve that already exists. Bracing is generally recommended for curves between 20 to 40 degrees in adolescent patients with significant growth remaining. The main factor in achieving a high rate of bracing success is the number of hours a day that the brace is worn. Various spinal orthoses are available, with the most common being a Thoracolumbo Sacral Orthosis (TLSO). The TLSO is named by the areas it is designed to stabilize: the thoracic, lumbar and sacral parts of the spine. It is cosmetically acceptable as it can be covered well by clothing. Wearing a brace is not an easy treatment for an adolescent. Even covered by clothing, it is hot, hard and can make the student feel self-conscious. Getting into a daily routine of wearing the brace while participating in activities helps with compliance, which is key to successful treatment.

Surgery: 
Some patients present with severe spinal deformity, and other patients scoliosis worsens despite compliant brace wear.  In these specific patients, surgery can reduce a portion of the curve and prevent it from increasing in the future. Usually, surgery is reserved for adolescents and pre-adolescents who already have a curve of 45 to 50 degrees or more. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft.

This type of surgery involves attaching rods to the spinal column to help straighten it. The bone graft between the affected vertebrae encourages fusion to prevent further progression of the curve. Instrumentation refers to the various rods, screws, hooks or wires that are used to hold the spine in the corrected position while the bone fusion occurs. The instrumentation is rarely removed. Following surgery, the fused section is no longer flexible. The average hospital stay is about two to three days, and the student can usually return to school in approximately four weeks. During the first six months after surgery, some limits will be placed on strenuous physical activity. After this healing phase, the surgeon will usually release the patient for all activities, including competitive, low-contact sports.
Does physical therapy help treat scoliosis?
The Schroth method is a nonsurgical option for scoliosis treatment. It uses exercises customized for each patient to return the curved spine to a more natural position. The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:

  • Restoring muscular symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Teaching you to be aware of your posture

This approach to scoliosis treatment was developed by Katharina Schroth and further popularized by her daughter Christa. Born in Germany in the late 1800s, Katharina Schroth had scoliosis that was unsuccessfully treated with bracing. She developed her own breathing technique and exercises to manage her scoliosis. She and her daughter opened a clinic, where they treated more than 150 patients at a time.
A Schroth-trained physical therapist or specialist should guide you in learning this program. The duration of this treatment varies and the patient is expected to continue exercises at home to keep scoliosis in check.

Scottish Rite Hospital is currently investigating the use of Schroth physical therapy alone and combined with brace treatment for patients with mild scoliotic curves.

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Share Your Story: The Journey of a Scoliosis Patient

Share Your Story: The Journey of a Scoliosis Patient

by | Jun 15, 2018 | Scoliosis & Spine

Meet Peyton, a spine patient who had surgery to correct her scoliosis. Peyton was diagnosed with adolescent idiopathic scoliosis (AIS) at age 14. Learn more about her journey below. 

Blog written by Peyton, age 21 of Frisco. 

Hi y’all! I’m Peyton and in honor of Scoliosis Awareness Month I am sharing my story with adolescent idiopathic scoliosis (AIS) at Scottish Rite Hospital. I’ll take you through my journey, beginning with diagnosis, my decision to have spinal fusion surgery and ending with recovery and where I am today.

My diagnosis process was actually a bit peculiar, as other hospitals and treatment centers that assessed my spinal curvature diagnosed the asymmetry they were seeing as “overdevelopment of muscle” on one side of my back. I was an all-star cheerleader/competitive athlete for 13 years growing up, and I was a flyer. For those who aren’t familiar with the sport of cheerleading, a flyer is the athlete in the air that executes body positions on the hands of the bases who are holding them up. Initially, the statement of “overdevelopment of muscle” seemed feasible, as I was consistently working and stretching one side of my back with little time and attention spent on the other side. The diagnosis wasn’t settling right with my mom. Additionally, my best friend’s mom, who also has scoliosis, was the first person to catch and actually call this so-called ‘overdevelopment’ scoliosis.

 

This confirmed my mom’s suspicions, so we met with my childhood pediatrician who referred us to Texas Scottish Rite Hospital for Children in Dallas, where I was diagnosed with adolescent idiopathic scoliosis at age 14 by Dr. Brandon Ramo.

Peyton and dad x ray_2

Once diagnosed, my treatment plan began immediately with bracing. I will be honest, as an athlete and highly active teen who was involved in numerous school organizations, school cheerleading, school athletics and all-star competitive cheerleading, the idea of being limited by bracing was not easy for me to wrap my head around. The goal was to be in the brace for at least 18 and up to 22 hours a day. If memory serves me correctly, upon hearing this, I immediately started crying. I thought this meant that I was going to have to stop cheering and, seemingly, everything else that I was involved in. At that point, Dr. Ramo discussed with me that time spent in the brace was an important goal, but I didn’t have to stop doing my activities. 

In his expert opinion, he credited the reason that my body didn’t physically reflect what was going on internally was because I was an athlete training at an elite level, thus, developing an extremely strong core. Physically, my body did show evident signs of scoliosis, such as what is commonly referred to as “the hump” on the right side of my back, uneven shoulders and a short torso, but nothing like what is commonly seen in patients who are not training at the level that I was. 

Fast forward four years. I had just turned 18 and was beginning my first year at Texas Christian University (TCU). While my all-star cheerleading career had come to an end, I was embarking on my college cheerleading journey that fall. Dr. Ramo and I agreed that because my growth plates were now closed, there was no need to brace while in college. The plan was to watch my curve and see if it progressed even after my growth plates had closed. Unfortunately, my curve did continue, officially making me a candidate for spinal fusion surgery. As you can imagine, this was not the greatest of news. From the second I was diagnosed, I had been adamantly against surgery, and told my mom time and time again that I would never even consider it. 

Peyton
Dr. Ramo knew this. He also knew I wasn’t in pain and my condition wasn’t preventing me from living my dream and achieving my goal to cheer for a Big 12/Division 1 university. Our plan, at that point, was to monitor my curve throughout the next year. Dr. Ramo was careful to make certain that I understood the big picture while still giving me personal space to make my own informed decision. He communicated his opinion, which was that I would benefit greatly in the long run by electing to have the surgery. He told me to come to him when I was ready to entertain surgery as an option for myself and/or when my cheerleading career was finished – then we would talk.

Almost one year to the date later, I had what I call a “come to Jesus” moment. A light went off in my head and I just knew. I knew my body was changing. I knew, for the first time ever, that my body was physically reflecting what was taking place internally. I knew I needed the surgery. So, one month before the end of my sophomore year at TCU, I called my parents and asked them to schedule a consultation for surgery. When I arrived for my appointment in May 2016, there was a note on my chart that said “consultation.” When Dr. Ramo walked in and saw this, he thought it was a mistake. I told him it wasn’t, and I was ready. Being the miracle worker that I believe him to be, he scheduled my surgery for June 15, 2016.

I arrived for surgery early on the morning of June 15, 2016. My surgery was approximately six and half hours long with zero complications. The early morning hours on the day after surgery were a bit rough as they transitioned me from IV pain meds to oral. My team of nurses took absolute perfect care of me.

They were extraordinarily compassionate, while still making sure to keep me on track in terms of movement. I stayed in the hospital for three days and went home on day four after my procedure. Once I was home, I stopped taking all narcotic pain medications and, instead, alternated between hospital doses of Advil and Tylenol.

 

I also relied heavily on pillows, lots and lots of pillows, that helped prop me up and keep me comfortable while sitting or lying down. I highly recommend a wedge pillow for ease of getting in and out of bed.

Peyton and nurse pre op_1

My biggest tip is to move as much as possible during the day, especially if you feel yourself getting uncomfortable, and even during the night when you wake up to take medicine. It helps the muscles in your back not stiffen up so much as your body gets use to the new you. My recovery was just as my surgery, completely complication free. For this I will be forever grateful.

I believe that choosing to get spinal fusion surgery is the best decision I will ever make for myself. I know that’s a huge statement, but I whole-heartedly stand by it. My body is far better aligned now. Clothing fits me better. I am no longer self-conscious about the physical aspects of scoliosis, and as a matter of fact, I’m quite proud of my scar! It has been amazing to see how my body has changed and adjusted to how it’s supposed to be post-surgery. Physically, I can do absolutely anything I could before, other than pulling elite cheerleading body positions or yoga positions that require a lot of back arch flexibility.

To the entire staff at Scottish Rite Hospital, the gratitude I have for you is difficult to communicate. Thank you for giving me a body that will be physically capable of doing absolutely anything that I want to do for the rest of my life.
I celebrate two years since my surgery today, June 15, 2018!

 

Do you have a story? We want to hear it! Share your story with us.