UNC Health Talk

How to Spot and Treat Childhood Scoliosis

Many adults remember getting checked for scoliosis at school: You bent forward in front of the school nurse, who looked at your back and tried to spot any deformities. While these screenings are less common in schools today, it’s still important to monitor the spine health of your children as they grow.

Scoliosis is a significant side-to-side curvature of the spine that affects around 3 percent of children in the United States. It is usually diagnosed in childhood, which is also the best time to catch it to prevent serious side effects from developing.

While there is no single cause of scoliosis, it is often hereditary and can run in families. Joseph Daniel Stone, MD, specializes in pediatric orthopedics and orthopedic surgery for UNC Orthopaedics; he shares what parents need to know about scoliosis and its treatments.

What Defines Scoliosis?

Spinal curves are measured with a method called the Cobb angle, which measures a three-dimensional curve of a spine in two dimensions seen on X-ray. When the Cobb angle exceeds 10 degrees, it’s scoliosis. Spinal curves below 10 degrees are not considered a health issue.

“Lots of folks have a little curve in their spine,” Dr. Stone says. “We just call that a spinal curvature and this isn’t associated with anything bad.”

A spinal curve can occur in any part of the spine, but the area most commonly affected is the thoracic spine, which connects to the rib cage and helps to protect the lungs and heart. Scoliosis can grow as a child grows and stop getting worse when the child stops growing, except for when the curve exceeds about 45 degrees, Dr. Stone says.

When a curve is more than 45 degrees, scoliosis can be progressive, meaning the spinal curvature continues to get worse even when someone stops growing.

Severe cases of scoliosis can cause health complications. It could cause a person’s rib cage to push against their lungs, making it more difficult to breathe. It can also result in chronic back pain if left untreated, and cause changes in physical appearance. While girls and boys experience mild forms of scoliosis at the same rate, girls are at higher risk of having curves worsen and requiring treatment.

How Scoliosis Is Diagnosed

Adolescent boys and girls (10 to 15 years old) should be checked for scoliosis with a physical exam on an annual basis, Dr. Stone says. This can be done by a pediatrician at a well check. Some school nurses still screen for scoliosis.

In a typical screening, the patient bends forward while a healthcare professional looks at the sides of their back for asymmetry. Other signs of scoliosis include asymmetry in other parts of the body, such as the shoulders, ribs and waist, as well as the head not being centered above the pelvis.

A pediatrician who suspects scoliosis might order an X-ray for a closer look or refer the child to a pediatric orthopedist.

Treatments for Scoliosis

There are three methods for treating scoliosis: watch it, brace it or fix it. The magnitude of the curve and the age of the patient will determine which option is best.

1. Watch it.

If the curvature of the spine is less than 20 degrees, regardless of the patient’s age, doctors will usually recommend monitoring the issue at regular checkups. This method can be coupled with a specific type of physical therapy called the Schroth Method that uses stretching, strengthening and breathing to help prevent the spine from curving any further.

2. Brace it.

If a spine curvature is between 20 and 45 degrees and the patient is young and has significant growing left to do, bracing can be a good option to prevent any additional curving that could require surgery to correct. Bracing is also an option if a patient does require surgery but needs to grow more before surgery is performed.

Modern braces are more subtle than previous metal braces, which could be downright clunky.

“I tell patients that the only people who typically know about your brace are you and the people you tell about it,” Dr. Stone says.

Today’s braces are made from plastic and foam that are fitted to the contours of a patient’s body. Bracing also can be coupled with Schroth Method physical therapy.

3. Fix it.

If a spine curvature is greater than 45 to 50 degrees, surgery is often recommended. There are several surgical options available, depending on the age of the patient.

“Surgery typically entails straightening the spine,” Dr. Stone says. “We want to involve as few joints as possible to maximize mobility so people can do what they want to do down the road.”

Surgeons want to operate after the patient is done growing but must balance this with the need to maximize the correction while including as few parts of the spine as possible. The goal is to create a well-balanced and stable spine that does not inhibit or impact their future physical abilities, Dr. Stone says.

The standard procedure to correct scoliosis is a posterior spinal fusion, in which the facet joints—connections between the bones of the spine—are fused together and no longer move, preventing a curve from getting worse.

For some patients, a relatively new fusionless procedure called anterior vertebral body tethering may be an option. This procedure allows for continued growth in younger patients without fusing facet joints while potentially preserving motion. Instead of fusing bone, a flexible cord or tether is implanted in the back that realigns the spine with continued growth for gradual correction of the curve.

Another fusionless procedure is distraction-based growing rods, which are rods implanted in the back that apply direct or indirect force on the spine to correct curvature while allowing for growth. The rods can be lengthened or adjusted through follow-up surgical procedures; a magnetic option that doesn’t require repeated surgeries is available, too.

Dr. Stone says the most important part of treating your child’s scoliosis is finding the right team.

“Make sure the center and the doctor treat a lot of patients and perform a lot of these surgeries,” Dr. Stone says. “Surgeons and institutions that do a lot of these surgeries have better outcomes than those that do not. Also look for providers who are involved in research, because they will be immersed in the latest evidence-based treatments.”


If you would like to have your child screened for scoliosis, or he or she has been diagnosed and needs treatment, find a pediatric orthopedist near you.