What is scoliosis and how is it commonly treated?
Scoliosis is a three-dimensional deformity that causes the spine to curve from side to side, making an S shape. The most common type of scoliosis is adolescent idiopathic scoliosis. Idiopathic means that the cause is unknown. However, the condition can be hereditary, so physicians frequently inquire about family history of scoliosis. It most commonly occurs between the ages of 10 and 18. However, it can also affect young children as well as patients with neuromuscular disorders such as cerebral palsy and muscular dystrophy.
There are a variety of treatments used to treat scoliosis. What we can offer depends a lot on the size of the curve, the age of the patient, and how much growth the child has left.
I typically talk to families about three options:
Observation – continue to monitor every four to twelve months
Bracing – for moderate curves in children with growth left
Surgery – for severe curves
How do you determine if a patient will require surgery to correct scoliosis?
To help us decide the best course of treatment, we measure the curvature of the spine in degrees. A scoliosis curve of 10 to 15 degrees usually means that nothing needs to be done except for regular checkups until puberty and growth are complete, as the curvature of the spine usually doesn’t get worse after that point. If the curve is 20 to 40 degrees, I will generally suggest a back brace. An angle of 40 or 50 degrees or more may mean that surgery is necessary.
We typically recommend surgery when scoliosis is large enough to progress into adulthood. The timing of surgery and what surgery is recommended will depend a lot on the age of the child. In adolescent idiopathic scoliosis, curves less than 45 to 50 degrees when kids are skeletally mature tend to not progress in adulthood. However, curves above this threshold tend to progress. This is why we frequently recommend surgery around 45-50 degrees.
The goal of surgery is to correct the spine as safely as possible and to prevent progression of the scoliosis. Problems associated with untreated large curves in adulthood are issues with breathing and pain.
How do you know if/when surgery is the right option? How can a parent discuss this option with their child?
This is a great question. There are a lot of factors that go into the decision to proceed with surgery. Often, the timing and recommendation of surgery depends on the stage of growth, curve pattern and the location of the curve. I think each child’s case is unique. Bottom line is that the family and child must be comfortable to proceed. Families need to make sure they are educated to the risks and benefits.
I always encourage parents to talk with their children after an office visit. Often times, the teenager doesn’t want to ask the doctor a lot of questions. I recommend that the family discuss the situation at home and write down any questions they have. I can answer any additional questions at the next visit or over the phone. Parents, children and physicians need to work together to make decisions for treatment, and open communication is the best way to address this.
There are a lot of great resources for patients and families to help them understand scoliosis and even talk directly with people that have been through the process prior to proceeding.
How active can a child with scoliosis be? Can they participate in organized sports or other activities?
They can be as active as they want to be. For most children, return to activities occurs by about three months after surgery. Returning to sports might take a little longer but nearly all patients return to their sport without restrictions. Most surgeons prefer that kids not return to major contact sports after surgery, such as football, but if I am treating children with braces or observation, I let them continue all activities as tolerated with no restrictions.
What other, more complex spinal disorders are treated at Levine Children’s Hospital?
We have a comprehensive spine program including treatments and techniques for children of all ages. All three of the pediatric orthopedic surgeons at Levine Children’s Hospital are well versed, trained, and published in various spine treatments and techniques. This ranges from casting in young children, growing spine instrumentation for children under 10 years old , and spinal fusions in older children.
We have significant experience in the treatment of various complex spinal problems such as congenital scoliosis, early onset scoliosis, kyphosis, spondylolysis (stress type fracture), and spondylolisthesis (stress fracture with slipping of one vertebra on the other). The latter two are common in younger kids, particularly those that participate in impact sports like gymnastics. We also have experience with spine tumors like neurofibromatosis.
What makes the experts at Levine Children’s Hospital uniquely qualified to treat these conditions?
Our multidisciplinary team combines the knowledge and skills of some of the region’s top pediatric subspecialists, including orthopedic surgeons, neurosurgeons, neurologists, pulmonologists, cardiologists, and rehabilitation experts. Our spine program involves three fellowship trained pediatric orthopedic surgeons who have trained at three different pediatric hospitals that are all well known for their own spine programs. We work in tandem with our pediatric neurosurgery colleagues as well as an orthopedic surgery partner that is fellowship trained in spine and tumor.
A little bit about Dr. Scannell:
Dr. Scannell and his wife, Kasey (a pediatrician at Charlotte Pediatric Clinic), are kept busy by their two young daughters (ages five and two). He moved to Charlotte when he was ten years old and graduated from Charlotte Catholic High School. He swam competitively as a child and at the University of Georgia where he was an NCAA All-American and competed in the 2000 Olympic Trials. He did his residency at Carolinas Medical Center including a year-long research fellowship. He then spent one year in San Diego for his pediatric orthopedic fellowship before returning to Charlotte to practice at Levine Children’s Hospital. In between a busy family and professional life, he fits in 5 a.m. workouts and loves to watch college football (UGA, of course).
Levine Children’s Specialty Center – Pediatric Orthopedics
1001 Blythe Blvd., Suite 200
Charlotte, NC 28203