Treatments for idiopathic scoliosis in children

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How we'll treat your child's scoliosis depends on the complexity and severity of her condition. Boston Children's Hospital's Spinal Program provides comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

At Boston 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 our researchers and clinicians. 

Non-surgical options for idiopathic scoliosis

Scoliosis brace fitting

Simple observation and monitoring

Once an abnormal spine curve has been detected, it's important to monitor the curve as your child grows. In many cases, your child's curve may require only close monitoring during skeletal growth. Your Boston Children's physician will determine your treatment plan and follow-up based on your child's 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 the 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 in order to partly correct the curve or prevent it from increasing. A bracing program may help avoid surgery.

Casting

In certain situations—as in some cases of early-onset (infantile) idiopathic scoliosis—body casting is indicated.

Surgical options for idiopathic scoliosis

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)
•   MAGEC (MAGnetic Expansion Control) System, an adjustable growing rod system that uses magnetic technology and
    a remote control to non-invasively lengthen the device

Thoracoscopic anterior spinal surgery and instrumentation

Spinal osteotomy

Controlled breaking or cutting and realigning of bone into a corrected 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

When should I consider treatment options for my child?

Your Boston Children's orthopedist will make treatment determinations depending on your child's age, the type and progression rate of her curve, the prediction of further curve progression and other factors. Typical treatment plans for idiopathic scoliosis can include:

Adolescent idiopathic scoliosis: 10 to 18 years of age

   •   curves less than 25 to 30 degrees observed and monitored regularly
   •   bracing for curves 30 to 40 or 45 degrees (prefer to use on children who are still growing)
   •   consider bracing for curves that progress rapidly to 20 to 25 degrees
   •   consider surgery for curves larger than 40 to 50 degrees

Juvenile idiopathic scoliosis: 3 to 9 years of age

   •   diagnostic MRI if curve is more than 20 degrees or atypical
   •   curves less than 20 degrees observed and monitored regularly
   •   bracing for curves 20 to 50 degrees
   •   bracing for smaller curves that progress rapidly to 20 to 25 degrees
   •   growing rods or vertebral stapling for very large curves or some curves not responsive to bracing

Infantile (early-onset) idiopathic scoliosis: birth to 3 years of age

   •   brief observation to determine if curves are self-resolving
   •   MRI for diagnosis in persistent curves
   •   casting followed by bracing for persistent or larger curves
   •   surgery for very large curves (often dual growing rods)

Caring for your child after surgery

In the unlikely event that your child needs surgery (spinal fusion) to correct her scoliosis curves, preparation for—and attention to—her care during the healing period will help ensure a positive outcome:

   •   For about three months after surgery—and to some extent throughout the healing period—she
       must restrict certain physical activities, such as running, sports, lifting, bending and twisting. After
       three months, she can gradually return to nearly all activities.
   •   Some at-home modifications in advance of her surgery will help her avoid activities and motions
        that put her fusion at risk:
          -  Place often-used items within easy reach—no bending.
          -  Place groceries on shelves—no lifting heavy grocery bags.
          -  Modify your expectations of her chores—no bed-making or other bending/twisting activities.
          -  Consider putting her bed on the same floor as the bathroom.
   •   Follow your doctor's directions for physical therapy (stretching, strengthening and appropriate
        aerobic activity).

Caring for your child as she grows

As your child grows, your orthopedist will monitor her curve through frequent check-ups. Also, be sure to 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.

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.

Coping and support

At Boston Children's, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

•   getting to Boston Children's
•   accommodations
•   navigating the hospital experience
•   resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with scoliosis. How will it affect my child long term? What do we do next? Boston Children's can help you connect with extensive resources to help you and your family through this stressful time, including:

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   •   patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical
       therapists will be on hand to walk you through your child's treatment and help answer any questions you may
       have—Will my child need surgery? How long will her recovery take? How should we manage home exercises
       and therapy?
We'll help you coordinate and continue the care and support you received while at Boston Children's.
   •   parent-to-parent: Do you want to talk with someone whose child has been treated for your child's form of
       scoliosis? We can often put you in touch with other families who've been through the same process or procedure
       that you and your child are facing, and who will share their experiences.
   •   faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our
       program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith
       traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital
       experience.
   •   social work: Our social workers and mental health clinicians have helped many other families in your situation. We
       can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to
       coping with illness and dealing with financial issues.

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We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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