About Scoliosis

I. Introduction –

A sports physical, a casual look in the mirror, trying on a bathing suit – a casual activity that shows some curvature of the spine. A trip to the doctor and the diagnosis is confirmed. You have scoliosis! How will it change your life? What if you have to wear a brace? What if you need surgery? Who can you turn to?

There are two things to keep in mind about curvature of the spine. First, most people with scoliosis do not have any medical or physical problems. Scoliosis is a shape, like having broad or narrow shoulders. It is not a disease. It is simply the shape of your spine.

The second and most important thing to remember is that you are not alone. Somewhere around one child in fifty is diagnosed with scoliosis, so most likely there are people in school or church or on your sports teams who also have the diagnosis. Many of them are as concerned as you are, and would all like to reach out for comfort and support in dealing with their issues.

II. What is Scoliosis? 

Scoliosis is the technical name for curvature of the spine. The curve is usually side to side best seen when the back is viewed staright on. There may be a c- or an s-shape to the spine and there is frequenlty one or more raised portion, or prominences either in the upper back along the ribs or in the lower back just above the hips. The prominence may look and feel like swelling or tightness in the muscles. You may also have a shoulder blade that stands out or one hip that seems higher than the other. We don’t know what causes scoliosis. It seems to run in families, so if you have it, there is a 3-5 % chance your sisters or brothers might have it as well. We now know that there are certain areas of the genes, the parts of the cells that manage how you grow and develop, that seem to be more involved with scoliosis. Recently a special test was developed that can test your genes to see if you are risk for progression of the curve. Your doctor will tell you if the test is right in your case.

Most people start showing signs of scoliosis when they start growing quickly as teenagers. This is typically around age eleven to thirteen in girls and twelve to fourteen in boys, although any age child can have scoliosis. The younger you are when it first shows up and the more growth you have remaining, the more of a possibility the curve has to get bigger.

Most scoliosis does not worsen with time. A mild curve is very likely to stay mild throughout life, or even to get better as you grow. The only problem that these curves may cause is occasional back pain.
Other curves may get worse with time and growth. That is why the doctor needs to check your back frequently as you continue to grow. Although it is unusual, some curves may even continue to get worse after you are fully grown. Those curves may require bracing or even surgery to keep them from getting too bad.

III. Living with Scoliosis –

Scoliosis usually does not affect the function of the back. Most people with even severe curves have flexibility. Also, it does not pose any risk for injury to the back aside from possible muscle strain. So you should be able to keep playing all sports and doing all activities, including dance, cheerleading, gymnastics and other flexibility sports. In fact, the stronger the back muscles are and the more athletic you stay, the less likely you will develop any back pain. Unfortunately, exercise programs do not stop the curve from getting worse if it is going to do so.

I recommend a full stretching program before sports or other activities to prevent any muscle problems. In addition, core strength exercises are very effective for scoliosis. Sit ups, pelvic crunches, or exercises on a Pilates Ball are very helpful. Most kids are concerned about the appearance of their back with scoliosis, but there are things that kids can do for the curvature. Wearing looser clothing may help if you are worried about the way your hips or shoulders look, and bright colors will draw attention to the clothes. A personalized hairstyle will draw attention to your face and other features. And remember that a smile and bright eyes are always seen first.

IV. The Back Brace –

In some cases, if the scoliosis is getting bigger, you will be asked to wear a brace to try to keep the curve in line. For the most part, a brace will not correct spinal curvature.

There are two main types of brace currently being used. The first is a flexible brace. This is based on the observation that stretching of the back can improve the alignment on a temporary basis. The flexible braces are made up of straps which pull and rotate the spine into a straighter alignment. So far, there is no evidence to show that flexible braces are effective at correcting scoliosis or preventing the curve from getting worse.

The most common type of back brace used is a rigid shell of light plastic. There are three types of rigid brace. The first is a brace with an upright portion that comes up to the neck, called a Milwaukee brace. This is a brace that is best suited for curves that are very high in the back or that are associated with rolling forward of the shoulders (“kyphosis”). Although it is very effective, the Milwaukee brace is difficult to wear throughout the day because of its size and bulk.

A variant of the Milwaukee brace is the underarm upright or Boston brace. This uses pressure pads and cut-outs in the shell to correct the alignment. The Boston brace has an excellent track record and because it is cut below the arms, it is easy to hide under clothing. The down side is that it is most effective when worn eighteen to twenty hours per day.

In my practice, I favor the use of a bending brace, specifically the Providence type. This kind of brace over corrects the spine by holding you in a bending position. Because of the excellent correction and the fact that the back will maintain the corrected position for a time even when the brace is off, it is effective with only ten to twelve hours of wear. Since the Providence brace does not have to be worn to school, most kids like it more and are more willing to use it.

All of the braces are best for moderate curves in people with a year or more of growth remaining. If the curve is up too high on the back or if it is too large, bracing may not be an option. If a brace is recommended, you will probably have to wear it until you are fully grown. Some braces may cause muscle strain, so exercises will be helpful during the time you are wearing one. And if the brace is hurting too much, be sure to tell your doctor or the brace maker so that it may be adjusted or another brace can be tried.

V. Scoliosis Surgery –

If a curve grows too large or if the back is too shifted, then surgery may be required. Back surgery is a big deal, but it is safe and very effective. In most cases you will be back to school or other non-sports activities by one month, and able to do most sports by three months. Most of the people I have done surgery for tell me that it is about six months, though, until they really feel like themselves again.

The surgery corrects the alignment of the spine and then fuses the curved area in a straight position using bone graft and rods. The rods go along the spine, not inside it, and there is very little risk of damage to the spinal cord and the nerves which are within the spine. Different curves call for different techniques, but in general, the rods are held in place with hooks which are pushed apart to stretch the curve out. The rods are then rolled over into the middle of the back to straighten out the prominences. The surgery takes several hours to perform during which time you are asleep in the operating room. You will wake up after the case is over and go to the recovery room and then the Pediatric Intensive Care Unit (or PICU) where there are more nurses to take care of you. You will start moving, sitting up, standing and walking on the day after the surgery and most kids can go home by three or four days after the surgery is done.

After surgery, you will have a course of physical therapy to work on motion and flexibility in your back. You will probably have to take some pain medicine for about two to three weeks afterwards, although most kids come off the strong medicine fairly quickly. When you have regained your motion and your fitness, and when the spine has fully healed, you can return to almost any sport activity. Ask your doctor about specific restrictions.

VI. Conclusion –

Although curvature of the spine may have a large impact on your life, it is important to remember that you are still the same person as you have always been. You can continue to do all the activities and sports that you enjoy, even if you need a brace or surgery.

Also, remember that there are many other people who have the condition too. Try to find a friend or someone your age to talk with and ask questions. It is your spine and your health, so take control of it and learn as much about it as you can.

(Excerpted from the booklet SCOLIOSIS – An Owner’s Guide, by Keith Mankin MD FAAP, 2008,
rights reserved)