Scoliosis

Treatment

Pediatric orthopedic surgeons have extensive training in the nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. They work closely with an orthotist – a specialist who fits, adjusts and supervises the use of braces – and other medical team members to treat scoliosis patients.

Most children with scoliosis have mild curves of less than 20 degrees and don't need a brace or surgery. Checkups every four to six months are important to ensure that curves in the spine do not progress. Growth, young age and large curve size are the biggest risk factors that an existing spinal curve may worsen.

Treatments decisions depend on the child's age, stage of growth, and the degree and pattern of the curve. Mayo specialists are trained to analyze these factors to determine best treatment; spinal curves of 25 to 40 degrees typically respond well to bracing technology and spinal curves greater than 40 to 50 degrees generally call for surgery.

Bracing
Patients who are still growing, and whose curves are 25 to 40 degrees, often benefit from a brace. If a patient complies with therapy, a brace is nearly 100 percent effective in preventing surgery. Brace therapy is considered effective if the curve has progressed 10 degrees or less from vertical after growth is completed (approximately by age 15 in girls and 17 in boys).

There are two main types of braces. The most widely used bracing system is a thoracolumbosacral brace (TLSO). TLSOs are custom-molded plastic braces that fit closely under the arms and around the rib cage, lower back and hips. A TLSO is also called an underarm or low-profile brace. Another, less-used type of brace is the Milwaukee brace, a full-torso brace that is sometimes used to treat curves in the upper spine. Read more about scoliosis bracing systems.

Surgery
If a patient's spinal curvature is greater than 40 to 50 degrees, surgery is usually recommended; the procedure is commonly performed through an incision in the back. Mayo surgeons use two metal rods, screws, wires and hooks to correct the curve and to hold the spine so it can fuse into the corrected position as it heals. Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed on children, but it is successful more than 95 percent of the time. Read more about scoliosis surgery.

Other Therapies
Mayo Clinic does not endorse alternative therapies to braces and/or surgery for treatment of scoliosis. Such therapies may include electrical stimulation of muscles, chiropractic manipulation, "strapping systems" or exercise. These treatments are not effective and do not successfully treat scoliosis. Alternative treatments are usually not dangerous in themselves, but may cause harm because they delay the start of effective treatment.

Patient Education
A team of Mayo professionals educates patients and their families about how to comply with proper treatment and cope with physical changes that accompany scoliosis. They make recommendations about how to forge a strong supportive peer group through friends and family, which helps children deal with the emotional and social implications of the disease and it's associated treatment regime.