Scoliosis - Treating scoliosis in children

If your child has scoliosis, the treatment they receive will depend on their age and the severity of their condition.

There are three main treatment options:

• observation
• bracing
• surgery

These are described below.

Observation

Treatment for scoliosis is often unnecessary because most cases are not severe and the condition often corrects itself as the child grows.

However, X-rays are needed every six months so that the progress of the curvature can be carefully monitored.

Bracing

If the curve of your child's spine is more severe (with an angle of more than 20 degrees) or it gets gradually worse, a brace will usually be required. A brace cannot cure scoliosis or correct the curve, but it can stop the curve from getting worse.

The brace will need to be carefully fitted to your child's spine. To do this, a cast of your child's back will need to be taken. This can be done on an outpatient basis, which means that your child will not have to stay overnight in hospital. Instead, they will have one or more appointments at a hospital or clinic.

It is usually recommended that the brace is worn for 23 hours a day, and that it 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 is recommended that the brace is removed during contact sports.

It is important for children who wear a brace to take regular exercise. This will help improve muscle tone and body strength, and will help make wearing the brace more comfortable.

The brace will have to be worn for as long as your child's body is still growing. Boys typically stop growing at around the age of 17 and girls typically stop growing at around the age of 15.

Most braces are made of rigid plastic, although a type of flexible brace has been developed more recently. Availability of flexible braces is limited however, and they are only available privately in some areas.

In general, modern back braces are designed so that they are virtually impossible to see under loose-fitting clothing

Surgery

If your child's scoliosis is severe (if their spine has a curve of more than 50 degrees), or other treatments are unsuccessful, spinal fusion surgery may be required.

Spinal fusion surgery is a complicated technique where the spine is straightened using metal rods and screws, before being fused into place using bone grafts.

The surgery will take several hours. After surgery, your child will be transferred to an intensive care unit (ICU), where they will be given intravenous fluid (administered through a vein) and pain relief. Most children are well enough to leave intensive care after 24 hours, although they will often need to spend another 5-10 days in hospital.

After the operation, most children can return to school after four to six weeks and can play sports a few months after having surgery. Some children may need a back brace to protect the metal rods after surgery.

Your child will need to return to hospital about every six months to have the rods lengthened to keep up with their growth. This is usually done as an outpatient procedure, using small incisions (cuts) in the back.

A newer type of rod that can be extended using magnets and an external remote control has also been developed, and was approved for use by the National Institute for Health and Care Excellence (NICE) in June 2014. Incisions are not required to lengthen these rods.

Sometimes the rods are removed during surgery when your child is older and their spine has grown, although they may be left in if they don't cause any problems.

Risks of spinal fusion surgery

There are several risks associated with spinal fusion surgery. It will not be recommended for your child unless the surgeon feels the benefits outweigh the risks. It is important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment.

The known risks of spinal fusion surgery are described below:

• Rod displacement. In around 5% of people who have surgery, one of the rods used to straighten the spine will move from its correct position. This should not cause any discomfort, but additional surgery may be required to return the rod to its correct position.
• Pseudarthrosis occurs when one or more of the bones used to fuse the spine into place fails to graft properly. Pseudarthrosis happens in around 1-5% of cases. It can cause mild discomfort and, in some people, can also cause some loss of the correction of the curvature of the spine. Further surgery will be needed to re-graft the relevant bones.
• Infection. Around 1-2% of people develop an infection after surgery. However, this can usually be easily treated with antibiotics.
• Nerve damage. In very rare cases (in about one or two cases in every 1,000), spinal fusion surgery will cause damage to the nerves in the spine. The results of this nerve damage can be relatively mild (a feeling of numbness in one or both legs), or it can be more severe and cause a loss of all lower bodily functions (paraplegia).

Additional therapies

There is no reliable evidence to suggest that additional therapies such as osteopathy (manipulation of the muscles, nerves and joints), reflexology (massage of certain areas of the body to improve general health) and acupuncture (sticking needles into certain points of the body to improve health) can be used to correct the curvature of the spine or stop it progressing.

However, physiotherapy may be beneficial when used in combination with a back brace.