If your child has scoliosis, their treatment will depend on their age and how severe it is.
The main treatment options are:
These are described below.
There is a separate page about treating scoliosis in adults.
Treatment is not always necessary for very young children because their condition often corrects itself as they grow.
However, if the curve does not correct itself, it can reduce the space for the internal organs to develop in, so careful monitoring by a specialist is important.
Your specialist will usually recommend having regular X-rays to monitor the curvature to see if it improves, stays the same, or gets worse.
In some cases affecting young children, the spine may need to be guided during growth in an attempt to correct the curve. In a child aged under two years of age, this can sometimes be achieved by using a cast.
A cast is an external brace to the trunk made out of a lightweight combination of plaster and modern casting materials. The cast is worn constantly and cannot be removed, but is changed regularly to allow for growth and remodelling.
The cast will be changed under anaesthetic every two to three months with the aim of gradually straightening the spine. However, your child may still need to use a removable brace (see below) after treatment.
If the curve of your child's spine is getting worse, your specialist may recommend they wear a back brace while they are growing. A brace cannot cure scoliosis or correct the curve, but it may stop the curve from getting worse.
However, while there is some evidence bracing may be of benefit in certain cases, it’s not recommended by all scoliosis specialists.
If a brace is used, it will need to be carefully fitted to your child's spine. To do this, a cast of your child's back may need to be taken. This can be done as an outpatient which means that your child will not have to stay overnight in hospital.
Braces are often made of rigid plastic, although flexible braces are sometimes available. In general, modern back braces are designed so they are difficult to see under loose-fitting clothing.
It's usually recommended that the brace is worn for 23 hours a day, and is only removed for baths and showers. The brace should not interfere with normal everyday activity and can be worn during most non-contact sports. However, it should be removed during contact sports and swimming.
Regular exercise is important for children wearing a brace. This helps improve muscle tone and body strength, and will help make wearing the brace more comfortable.
The brace will usually have to be worn for as long as your child's body is still growing. For most children, this will mean they can stop wearing it when they are around 16 or 17 years old.
If your child has stopped growing and their scoliosis is severe, or other treatments have been unsuccessful, corrective surgery may be recommended. They type of surgery will depend on your child’s age.
Surgery in children
For younger children, generally those under the age of ten, an operation may be carried out to insert growing rods. These rods aim to allow for continued controlled growth of the spine while partially correcting the scoliosis.
After surgery to insert the rods, your child will need to return to their specialist every 4-6 months to have the rods lengthened to keep up with the child's growth. This procedure will be done through a small incision, and takes place often as a day case or an overnight stay.
In some cases, rods that can be lengthened using external magnets during an outpatient appointment may be used. Many children will also have to wear a brace to protect the growth rods.
When your child stops growing, the adjustable rods can be removed and a spinal fusion (see below) will be carried out.
Surgery in teenagers and young adults
In teenagers and young adults whose spine has stopped growing, an operation called a spinal fusion may be carried out.
This is a major operation where the spine is straightened using metal rods attached with screws, hooks, and/or wires, and bone grafts are used to fuse the spine in place. This metalwork will usually be left in place permanently, unless they cause any problems.
The surgery will take several hours. After surgery, your child will be transferred to an intensive care unit (ICU) or high dependency unit (HDU), where they will be given fluids through a vein (intravenously) and pain relief. Most children are well enough to leave intensive care after a day or two, although they will often need to spend another five to 10 days in hospital.
After the operation, most children can return to school after a few weeks and can play sports after a few months. Contact sports should be avoided for 9-12 months. Occasionally a back brace may need to be worn to protect the metal rods after surgery.
Risks of surgery
Spinal fusion surgery is a major operation which, like any surgical procedure carries a risk of complications. It will not be recommended unless the surgeon feels the benefits outweigh these risks.
Some of the main risks the spinal fusion procedure include:
- bleeding – if this is severe your child may need a blood transfusion
- wound infection – this can usually be treated with antibiotics
- the implants moving or the grafts failing to fuse properly – additional surgery may be required to correct this
- in rare cases, damage to the nerves in the spine – this can lead to permanent numbness in the legs, and can sometimes cause paralysis of the legs and loss of control of the bowels and bladder
It's important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment. Make sure you discuss the potential complications with your child's surgeon.
There is no reliable evidence to suggest that other therapies such as osteopathy and chiropractic can be used to correct the curvature of the spine or stop it progressing.
The role of scoliosis specific exercises is currently under investigation.
Physiotherapy may be beneficial when used in combination with a back brace. Exercise can help significantly with any muscular pain experienced with scoliosis, and back health in general.