Scoliosis

At Children’s Hospital Boston, our Spinal Program team develops innovative treatments for scoliosis and other spine problems. And because our research informs our treatment, we’re known for our science-driven, experience-based approach.

We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in innovative, family-centered care, our physicians never forget that your child is precious, and not just a patient.

In dealing with your child’s scoliosis, you may want to know the basics about the spine and about the several forms of this spinal problem.

What is the spine?

Made up of many individual bones called vertebrae, the spine is joined together by muscles and ligaments. Flat, soft discs separate and cushion each vertebra from the next. Because the vertebrae are separate, the spine is flexible and can bend. Together the vertebrae, discs, muscles and ligaments make up the spine or vertebral column.

Different regions of the spine are named differently. The cervical spine refers to the neck, the thoracic spine to the chest, and the lumbar and sacral spines to the lower back.

What are normal and abnormal front-to-back spine curves?

The normal spine is strong and mobile. While it varies in size and shape from person to person, the healthy spine has natural front-to-back curves that enable us to walk, balance, sit, stand and twist—all of which are complex interactive movements. When these natural front-to-back curves become too large, they can present a potential problem:

• When the backward curve in the thoracic spine is too great, the condition is called kyphosis (thoracic hyper-kyphosis, “round back”).
• When there’s not enough backward curve in the thoracic spine, the condition is called hypo-kyphosis.
• When the natural outward curve in the thoracic spine is actually reversed, curving into the chest, the condition is called thoracic lordosis.
• When the inward curve in the lower back is too great, the condition is called hyper-lordosis (“swayback”).

Are side-to-side-curves normal?

No. Although the spine has natural curves from front to back, it shouldn’t curve sideways very much. A side-to-side curve is called scoliosis and may take the shape of an “S” (double curve) or a long “C” (single curve).

The scoliotic spine is also rotated or twisted to form a multi-dimensional curve. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the mid- (thoracic) and lower (lumbar) spine may be affected by scoliosis.

What is scoliosis?

Scoliosis isa condition in which the spine, in addition to the normal front to back curvature, has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it. In serious cases, lung function can be affected.

The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater on x-ray. The condition isn’t rare. It mainly affects girls—many of whom have mild forms of scoliosis, are never even aware of it, and never need treatment. Three to five children out of every 1,000 develop spinal curves that are considered large enough to require treatment. Idiopathic scoliosis does tend to run in families, although no one genetic link has been confirmed.

Scoliosis occurs, and is treated, as three main types:

• idiopathic scoliosis: the most common form of scoliosis, most commonly seen in adolescent and pre-adolescent girls. “Idiopathic” simply means that there's no definite cause. Nothing you or your child did caused it, and there’s nothing you could have done to prevent it.
  
  Fortunately, most cases require no intervention. Idiopathic scoliosis does tend to run in families, and girls are five to eight times more likely to develop it than boys. One exception is infantile idiopathic scoliosis, which occurs by the age of 3 years, and affects boys more than girls.

Idiopathic scoliosis is sub-classified as:

• adolescent: the vast majority of cases—mostly occurring in girls ages 10 to 18 years, often not needing intervention

juvenile: about 10 percent of cases—occurring in children ages 3 to 9 years

infantile (early-onset): about 5 percent of cases—more often occurring in boys from birth to three years of age, often self-resolving

• neuromuscular scoliosis: scoliosis that is associated with disorders of the nerve or muscular systems like cerebral palsy, spina bifida, muscular dystrophy or spinal cord injury

• congenital scoliosis: The spine forms and develops between three and six weeks after conception. Congenital scoliosis, the rarest form of the condition, results from abnormal in utero spinal development, such as a partial or missing formation or a lack of separation of the vertebrae.

What are the signs and symptoms of scoliosis?

Because of the many possible combinations of curvatures, scoliosis can be very different in different people. Common signs and symptoms of scoliosis may include:

• uneven shoulder heights
• head not centered with the rest of the body
• uneven hip heights or positions
• uneven shoulder blade heights or positions
• prominent shoulder blade
• when standing straight, uneven arm lengths
• when bending forward, the left and right sides of the back are asymmetrical

Symptoms that suggest scoliosis can resemble those of other spinal conditions or deformities, or may result from an injury or infection. - Click on images below

How do you diagnose scoliosis?

Doctors will use medical and family histories, physical exams and diagnostic tests to determine the nature and extent of your child’s spinal condition. Testing can include:

• x-rays
• magnetic resonance imaging (MRI)
• computerized tomography scan (CT or CAT scan)
• blood tests
• ultrasound (sonogram)
• bone scans
• bone density scans (dual-energy x-ray absorptiometry, DEXA, DXA)
• pulmonary function tests

How do you treat scoliosis?

Treatment for your child’s scoliosis depends on the nature and severity of her condition. Whether your child’s scoliosis is idiopathic-, neuromuscular- or congenital-related, Children’s Spinal Program provides comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

Treatments can include:

• simple observation and monitoring: Once an abnormal spine curve has been detected, it’s important to monitor the curve as the child grows. In many cases, your child’s curve may require only close monitoring while her spine grows. Your physician will determine your child’s treatment plan and follow-up based chiefly on her x-rays and physical exams.
   
• physical therapy: Scoliosis can often be helped by physical therapy. Our physical therapy team’s goal is to maximize your child’s physical functioning. Our therapists work closely with specialists in our Spinal Program to also provide exercise programs and additional therapies to address pain and the muscular imbalance that can be associated with spinal abnormalities.
   
• bracing: If your growing child’s curve shows significant worsening or is already greater than 30 degrees, your physician may recommend a bracing program, in which a scoliosis brace is designed specifically for your child’s particular curve. The brace holds your child’s spine in a straighter position while she is growing—to partly correct the curve or to prevent it from increasing. This may help avoid the need for surgery.

In neuromuscular scoliosis, bracing helps positioning and functioning.

• casting: In certain situations—as in some cases of early-onset (infantile) scoliosis—body casting is done to help the spine to straighten.
   
• surgery: If surgery becomes necessary, our Spinal Program’s orthopedic surgeons use the most advanced surgical techniques for correcting spinal problems, such as:
  • spinal fusion: the most common surgical procedure for treating spinal problems
    • Usually, a fusion and instrumentation are combined to correct and solidify the curve.
  • for younger growing children:
    • dual posterior growing rods (for early-onset scoliosis): control spinal deformity while allowing spinal growth with periodic lengthenings
    • expansion thoracostomy/VEPTR™ (titanium rib) procedure to control chest and spine deformity while permitting growth of both chest and spine
    • vertebral stapling (a minimally-invasive surgical alternative to bracing for scoliosis in some circumstances)
  • thoracoscopic anterior spinal surgery and instrumentation
  • hemivertebra and wedge resections (for congenital scoliosis)
  • spinal osteotomy: controlled breaking or cutting and realigning of bone into a corrected correct position; may be performed when there is significant rigid deformity
  • vertebral column resection: circumferential resection of a portion of the spine to permit correction of the most severe deformities.

For details see Treatment & Care for:

• idiopathic scoliosis
• neuromuscular scoliosis
• congenital scoliosis

What causes abnormal spine curves?

There are several causes of abnormal spinal curves:

• In many cases, as in idiopathic scoliosis, there’s no definite cause for (or way to prevent) the spine’s failure to grow as straight as it should.
• Some babies are born with spinal formation problems that cause the spine to grow unevenly—for example, congenital scoliosis, congenital kyphosis, spina bifida or Klippel-Feil anomaly.
• Some children have nerve or muscle (neuromuscular) diseases, injuries or other illnesses that cause spinal deformities—for example, cerebral palsy, spina bifida or muscular dystrophy. In these conditions, muscle abnormalities combined with the child’s growth result in deformity.

Other causes may include:

• bone dysplasias: many generalized abnormalities of bone formation are associated with scoliosis
• connective tissue disorders: conditions with abnormal tissues and ligaments, such as Marfan syndrome and Ehlers-Danlos syndrome
• differences in leg lengths: mild leg length differences may cause a slight curvature but rarely cause a serious curvature
• spinal cord injury with paralysis
• infection
• tumors

Will my child be OK?

Scoliosis is not a life-threatening condition, except in some early-onset scoliosis. The outlook for your child greatly depends on the nature and severity of her scoliosis and her age, since the amount of time remaining for her to achieve complete bone growth plays a big factor. Early diagnosis and early treatment can improve the outlook for many forms of scoliosis.

Children’s Hospital Boston’s research into spinal problems, including scoliosis, means that we can provide your child with the most innovative care available. As a result, the majority of children treated for scoliosis at Children’s have corrections that enable them to walk, play and live full lives.

FAQ

Q: What is scoliosis?

A: Scoliosis isa condition in which the spine, in addition to the normal front to back curvatures, has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it. Sometimes lung function can be compromised when the curvature is severe or starts very early in life. The condition isn’t rare. It mainly affects girls—many of whom have mild forms of scoliosis, are never even aware of it, and never need treatment.

Q: If my child has scoliosis, will she be OK?

A: Scoliosis is not a life-threatening condition, except in some early-onset scoliosis. The outlook for your child greatly depends on the nature and severity of her scoliosis and her age, since the amount of time remaining for her to achieve complete bone growth plays a big factor. Early diagnosis and early treatment can improve the outlook for many forms of scoliosis. Most children and adolescents diagnosed with scoliosis can look forward to normal, active lives.

Children’s Hospital Boston’s research into spinal problems, including scoliosis, directly informs how we care for your child. As a result, the majority of children treated for scoliosis at Children’s have had therapies that enable them to walk, play and live full lives.

Q: How does Children’s treat scoliosis?

A: Treatment for spinal problems depends on the nature and severity of the condition. Whether your child’s particular spinal condition is congenital-, idiopathic- or neuromuscular-related, Children’s Spinal Program provides comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care. Treatments can include:

• simple observation and monitoring
• physical therapy
• bracing
• casting
• surgery

Q: What are the signs and symptoms of scoliosis?

A: Because of all the possible combinations of curvatures, scoliosis can look quite different from child to child. Common signs and symptoms of scoliosis may include:

• uneven shoulder heights
• head not centered with the rest of the body
• uneven hip heights or positions
• uneven shoulder blade heights or positions
• prominent shoulder blade
• when standing straight, uneven arm lengths
• when bending forward, the left and right sides of the back appear asymmetrical

Symptoms that suggest scoliosis can resemble those of other spinal conditions or deformities, or may result from an injury or infection.

Q: If my child has—or is developing—scoliosis, what should I ask my Children’s doctor?

A: Ask your Children’s doctor:

• What is happening to my child, and why?
• Are other tests needed to diagnose my child?
• What actions might you take after you reach a diagnosis?
• What will happen with growth over time?
• Will there be restrictions on my child’s activities?
• Will there be long-term effects?
• What can we do at home?

Q: How is a spinal problem usually detected?

A: Most spinal problems are detected by a child’s parents or pediatrician, or by school screenings.

Q: How is scoliosis usually diagnosed?

A: Once a problem is detected, doctors will use a medical and family history, physical exams and diagnostic tests to determine the nature and extent of your child’s spinal condition and options for treatment. Testing can include:

• x-rays
• magnetic resonance imaging (MRI)
• computerized tomography scan (CT or CAT scan)
• blood tests
• ultrasound (sonogram)
• bone scans
• bone density scans (dual-energy x-ray absorptiometry, DEXA, DXA)
• pulmonary function tests

Q: Is scoliosis related to poor posture?

A: No. Scoliosis is a spinal abnormality. It’s neither a cause nor a result of poor posture.

Q: How common is scoliosis?

A: According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five out of every 1,000 children develop spinal curves that are considered large enough to require treatment. The condition is more common in girls than boys.

Q: What is the long-term outlook for children with scoliosis?

A: Scoliosis is not a life-threatening condition, except in some early-onset scoliosis. The outlook for your child greatly depends on the nature and severity of her scoliosis and her age, since the amount of time remaining for her to achieve complete bone growth plays a big factor. Early diagnosis and early treatment can improve the outlook for many forms of scoliosis. Most children and adolescents diagnosed with scoliosis can look forward to normal, active lives.

As your child grows, your orthopedist will monitor her curve through frequent check-ups. Be sure to also follow her regular program of well-child checkups. If your child is a teen, encourage her to live normally and to participate in sports and/or school activities. These will add greatly to her general health and sense of well-being.

Q: What causes abnormal spinal curves?

A: There are several causes of abnormal spinal curves:

• In many cases, as in idiopathic scoliosis, there’s no definite cause for (or way to prevent) the spine’s failure to grow as straight as it should.
• Some babies are born with spinal formation problems that cause the spine to grow unevenly—for example, congenital scoliosis, congenital kyphosis, spina bifida or Klippel-Feil anomaly.
• Some children have nerve or muscle (neuromuscular) diseases, injuries or other illnesses that cause spinal deformities—for example, cerebral palsy, spina bifida or muscular dystrophy. In these conditions, muscle abnormalities combined with the child’s growth result in deformity.

Other causes may include:

• bone dysplasias: many generalized abnormalities of bone formation are associated with scoliosis
• connective tissue disorders: conditions with abnormal tissues and ligaments, such as Marfan syndrome and Ehlers-Danlos syndrome
• differences in leg lengths: mild leg length differences may cause a slight curvature but rarely cause a serious curvature
• spinal cord injury with paralysis
• infection
• tumors

Q: Does scoliosis hurt?

A: Actually, most scoliosis isn’t painful in adolescents and children. But there's still the potential for significant risk of pain developing in adulthood.

Q: Will scoliosis affect my child’s lungs and/or other organs?

A:The lungs may be affected by severe scoliosis, particularly early-onset scoliosis. But even a severe spinal deformity doesn’t usually affect the function of other organs.

Q: Will my other children have spinal defects?

A: The possibility of a genetic component of spinal defects is still being studied. What’s known is that idiopathic scoliosis does tend to run in families. If you have a child with a spinal defect, it’s advisable to consult a geneticist, who can take a family history and discuss your particular situation.

Q: What is Children’s experience treating scoliosis?

A: At Children’s Spinal Program, we’re known for our clinical innovations, research and leadership. As a world center for the treatment of scoliosis, we offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Children’s researchers and clinicians.

Q: What are Children’s spine research and innovations?

A: The Children’s Orthopedic Clinical Effectiveness Research Center (CERC) helps coordinate research and clinical trials to improve the quality of life for children with musculoskeletal disorders, such as scoliosis. This collaborative clinical research program is playing an instrumental role in establishing evidence-based standards of care for pediatric orthopedic patients throughout the world.

Physicians in the Spinal Program are pursuing several areas of basic and clinical research based at Children’s and the Harvard Orthopaedics Biomechanics Laboratory. Research topics include:

• idiopathic scoliosis and congenital scoliosis
• spondylolisthesis and spondylolysis
• bone density studies of braced patients
• in vitromechanical testing of lumbosacral fixation devices
• computer-assisted strength analysis of vertebral metastases

For details see Research & Innovations.

Causes

Scoliosis can be:

• idiopathic (cause not definite—the most common form)
• neuromuscular (associated with a neuromuscular condition such as cerebral palsy or spina bifida)
• congenital (present at birth, caused by a failure of the vertebrae to form normally—the least common form)

Other causes may include:

• bone dysplasias: many generalized abnormalities of bone formation are associated with scoliosis
• connective tissue disorders: conditions with abnormal tissues and ligaments, such as Marfan syndrome and Ehlers-Danlos syndrome
• differences in leg lengths: mild leg length differences may cause a slight curvature but rarely cause a serious curvature
• spinal cord injury with paralysis
• infection
• tumors

Signs and symptoms

Because of all the possible combinations of curvatures, scoliosis can be very different in different people. Common signs and symptoms of scoliosis may include:

• uneven shoulder heights
• head not centered with the rest of the body
• uneven hip heights or positions
• uneven shoulder blade heights or positions
• prominent shoulder blade
• when standing straight, uneven arm lengths
• when bending forward, the left and right sides of the back are asymmetrical

Symptoms that suggest scoliosis can resemble those of other spinal conditions or deformities, or may result from an injury or infection.

When to seek medical advice

Scoliosis will usually become apparent as your child grows. Consult your pediatrician if her:

• shoulders are of uneven heights
• head isn’t centered with the rest of her body
• hips are of uneven heights or positions
• shoulder blades are of uneven heights or positions
• arms hang beside her body unevenly when she stands straight
• left and right sides of her back appear different in height when she bends forward

Questions to ask your doctor

If your child is diagnosed with scoliosis, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

Some of the questions you may want to ask include:

• What is happening to my child, and why?
• Are other tests needed to diagnose my child?
• What actions might you take after you reach a diagnosis?
• What will happen with growth over time?
• Will there be restrictions on my child’s activities?
• Will there be long-term effects?
• What can we do at home?

Who’s at risk

Risk factors for developing the most common form of scoliosis (idiopathic) include:

• age: With the onset of puberty, during the maximum growth spurt, signs and symptoms of scoliosis may begin to manifest themselves.
• gender: Girls are five to eight times more likely than boys to develop scoliosis.
• heredity: Idiopathic scoliosis tends to run in families.

Complications

Complications from adolescent idiopathic scoliosis after treatment are uncommon, the most common being back pain and residual curvature. However, if left untreated, adults with moderate or severe scoliosis can have progressively worsening curves that cause cosmetic disfigurement, back pain and in rare cases, difficulty breathing.

Treatment in adulthood after the curve has already become severe may be somewhat less successful than treatment during childhood or adolescence. By treating your child’s progressive curves early, we hope to keep them from becoming problems in adulthood.

Long-term outlook

Scoliosis is not a life-threatening condition, except in some early-onset scoliosis. The outlook for your child greatly depends on the nature and severity of her scoliosis and her age, since the amount of time remaining for her to achieve complete bone growth plays a big factor. Early diagnosis and early treatment can improve the outlook for many forms of scoliosis. Most children and adolescents diagnosed with scoliosis can look forward to normal, active lives.

As your child recovers and grows, your orthopedist will monitor her curve through frequent check-ups. Be sure to also follow her regular program of well-child checkups. If your child is a teen, encourage her to live normally and to participate in sports and/or school activities. These will add greatly to her general health and sense of well-being.

For teens

Besides the typical issues any teenager faces—from social acceptance to body changes and more—if you’re undergoing bracing and physical therapy for scoliosis, it’s true that you’ll also have to deal with medical appointments, feeling different and assuming a big personal responsibility for maintaining your own good health. If your scoliosis is mild or moderate, you may wonder why we need to monitor and treat it, since it may not be painful or bothersome.

It’s important for you to know that if left untreated until you’re an adult, your moderate or severe scoliosis can worsen, resulting in curves that cause cosmetic disfigurement, back pain and in severe cases difficulty breathing.

Treatment in adulthood after the curve has already become severe may be somewhat less successful than treatment during your adolescence. So, by treating your progressive curves early, we hope to keep them from becoming problems when you reach adulthood.

It may also help you to know that you can participate in sports and other normal activities—your general health will actually improve with an active lifestyle. Your brace can be removed for sports, and most braces can be worn, unseen, underneath your clothes.

If you feel overwhelmed, depressed or anxious through this important time in your transition to adulthood, speak to your doctor or counselor to get help.

For adults

If you were treated for scoliosis as a child, you’re probably being followed by your orthopedist and/or family doctor. And you’re probably doing well, with perhaps occasional back pain.

If your scoliosis was untreated during childhood, it may have:

• remained the same
• progressed (worsened), causing:
  • back pain
  • difficulty sitting or standing
  • stiffness, spinal rigidity
  • bodily asymmetry
  • deformity, gait dysfunction
  • rarely, and only in severe cases, impaired heart or lung function

Adult scoliosis is often treated with non-surgical therapies such as pain medication, applied heat and/or exercise. Bracing is rarely used for pain control in adults. And surgery for adults can be indicated to alleviate pain, increase function or to decrease deformity.

Adults who’ve been treated at Children’s during their childhood are often followed into adulthood for their pediatric condition by their Children’s orthopedist. We also see young adults with spine problems that originated in childhood.

What you can do at home

As your child grows, your orthopedist will monitor her curve through frequent check-ups. Be sure to also follow her regular program of well-child checkups. If your child is a teen, encourage her to live normally and to participate in sports and/or school activities. These will add greatly to her general health and sense of well-being.

Prevention

The great majority of scoliosis cases are idiopathic, meaning they have no definite cause. Nothing you or your child did caused it, and there’s nothing you could have done to prevent it.

Scoliosis glossary

• Adams forward bending test: a screening tool for scoliosis
   
• adolescent scoliosis: a classification of idiopathic scoliosis representing the vast majority of cases—mostly occurring in girls ages 10 to 18, often not needing intervention
   
• brace, bracing (spinal orthosis): If your growing child’s curve shows significant worsening or is already greater than 30 degrees, your physician may recommend a bracing program, in which a scoliosis brace is designed specifically for your child’s particular curve. The brace holds your child’s spine in a straighter position while she is growing in order to partly correct the curve or prevent it from increasing.
  
  There are many types of brace, including the Boston Brace developed at Children’s. A bracing program may help avoid surgery.
   
• casting: an option for holding your child’s spine in a straighter position while she's growing; used in specific situations, as in some cases of early-onset (infantile) scoliosis
   
• The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
   
• Cobb angle: an angular measurement on x-ray to evaluate the severity and degree of scoliosis curves
   
• congenital scoliosis: The spine forms and develops between three and six weeks after conception. Congenital scoliosis results from abnormal in utero spinal development, such as a partial or missing formation or a lack of separation of the vertebrae.
   
• diagnosis: identifying disease or injury through examination, testing and observation
   
• (dual posterior) growing rods: devices affixed to the spine (for early-onset scoliosis). These control spinal deformity while allowing spinal growth with periodic lengthenings.
   
• idiopathic scoliosis: the most common form of scoliosis. “Idiopathic” simply means that there is no definite cause. Nothing you or your child did caused the problem, and there’s nothing you could have done to prevent it.
   
• infantile idiopathic scoliosis (one of several types of early-onset scoliosis): a classification of idiopathic scoliosis representing about 5 percent of cases; the only type of scoliosis occurring more often in boys from birth to 3 years of age, often self-resolving but sometimes serious
   
• instrumentation: the metal rods, hooks, screws and wires implanted during spinal fusion surgery to correct the spinal curve and secure the spine in position while the fusion heals and becomes solid
   
• juvenile scoliosis: a classification of idiopathic scoliosis representing about 10 percent of cases—occurring in children ages 3 to 9 years
   
• neuromuscular: affecting, or characteristic of, both neural (nerve) and muscular tissue 
   
• neuromuscular scoliosis: scoliosis that's associated with disorders of the nerve or muscular systems like cerebral palsy, spina bifida, muscular dystrophy or spinal cord injury
   
• orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
   
• orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
   
• orthotics: the science of designing and fitting of devices such as braces to treat orthopedic conditions
   
• physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
   
• progression, curve progression: worsening of a scoliosis curve
   
• scoliometer: a surface measurement device for evaluating the angle of trunk rotation (ATR or scoliometer angle, which is not the ‘Cobb’ angle measured on x-ray)
   
• scoliosis: a spinal abnormality in which the spine, in addition to the normal front to back curvature, has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it. Scoliosis occurs in three main types: idiopathic (no definite cause), neuromuscular (associated with neuromuscular diseases) and congenital (present at birth).
   
• spina bifida (myelodysplasia): a condition in which there's abnormal development of the back bones, spinal cord, surrounding nerves and the fluid-filled sac that surrounds the spinal cord. This neurological condition can cause a portion of the spinal cord and the surrounding structures to develop abnormally. Scoliosis is often associated with this condition.
   
• spinal cord: a nerve bundle within the vertebral column that extends down from the brain stem. It conducts signals in both directions between the brain and extremities, and allows for bodily motion and sensation.
   
• spinal abnormality (spinal problem): a condition in which the spine develops abnormally—for example, congenital scoliosis or congenital kyphosis. Some are the result of nerve or muscle (neuromuscular) diseases, injuries or illnesses—for example, cerebral palsy, spina bifida, or muscular dystrophy. In some cases, there's no definite cause (idiopathic) or means of prevention for the spine’s failure to develop normally.
   
• spinal fusion: usually a solid fusion (solidification) of the curved part of the spine, achieved by operating on the spine, adding bone chips and allowing the vertebral bones and bone chips to slowly heal together to form a solid mass of bone called a fusion
   
• spine (spinal column, vertebral column): the series of moving vertebrae forming the axis of the skeleton and protecting the spinal cord
   
• spine curves, normal and abnormal: front-to-back and sideways curves of the spine
  • All spines have normal front-to-back curves. Abnormal front-to-back curves can indicate “round back” (hyper-kyphosis) or “swayback” (hyper-lordosis).
  • Normal spines do not have much sideways curvature. An abnormal sideways “S” or “C” curve can indicate scoliosis.
     
• VEPTR™ (titanium rib) procedure: an operation that expands the chest and allows continued growth of the chest and spine. A curved metal rod fits the back of the chest and spine, helping the spine to become straighter and allowing the lungs to grow and fill with enough air to breathe. The device is made longer as your child grows. The procedure is used for some early-onset scoliosis, with the device attaching to the ribs, spine or both.
   
• vertebra, vertebrae: the individual bones that form the spinal column
   
• vertebral stapling: a newer surgical technique that may prevent the curve progression in children and adolescents with moderate scoliosis. A minimally invasive procedure, stapling may be an alternative to bracing for some children at risk for progression of their scoliosis and the prospect of spinal fusion in their future.