Pediatric Scoliosis FAQ's

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What causes adolescent idiopathic scoliosis?

At this time, the exact cause of scoliosis is not known.  It is clear that there is some type of genetic component as scoliosis may run in families.  It also tends to occur in females much more commonly than males.  There is no evidence to prove that people of smaller or shorter stature are at different risks of scoliosis.  There is no evidence to prove that athletics places someone at higher risk of developing scoliosis either.

Is my child's back pain related to scoliosis?

The best answer is ... maybe.  The truth is that both scoliosis and back pain are both very common problems, especially in the adolescent population.  In addition, they are not mutually exclusive - meaning that a child can have both scoliosis and back pain.  It is unclear however, if one causes the other.  For example, there are adolescents who have no scoliosis and severe back pain, while others may have severe scoliosis and no back pain.  Therefore, it is very possible, and very likely, that smaller scoliosis curves do not cause back pain. 

Is the weight of my childs' backpack related to scoliosis?

No.  Backpacks do not cause scoliosis.  However, heavy backpacks are clearly associated with back pain.  

Can my child participate in sports and/or PE with scoliosis?

There is typically no inherent increased risk of playing sports when one has scoliosis. However, you should consult with your COA physician prior to participating, just in case.  There may be some rare circumstance in which sports may not be recommended.

Can physical therapy help with scoliosis?

Maybe, but unlikely.  There has been little scientific evidence to date to prove that scolisis is "corrected" with PT nor can it prevent progression.  However, there is a physical therapy technique, known as Schroth exercises, if done appropriately may be beneficial for small curves.  

PT, however, may be very beneficial for the adolescent with back pain.  Back pain in this age group is often due to relative weakness in core strength, especially immediately following the large adolescent growth spurt. 

Does a back brace correct scoliosis?

Typically - no.  Bracing has been shown to prevent curve progression in someone with a specific size of scoliosis (typically between 20-40 degrees), in a specific location in the spine, and still has a significant amount of growth remaining.  For example, if your child has been diagnosed with a 30 degree scoliosis curve at the age of 10, bracing may be effective at preventing the curve from progressing.  The goal of brace treatment in this example, would be to maintain the size of the curve at or below 30 degrees during the entire growth spurt.  The brace wear would stop once this child has stopped growing (i.e. - reached skeletal maturity). 

It is important to understand that bracing for scoliosis is not 100% effective.  Even with a well-made brace that is worn correctly and for the prescribed amount of time, the brace may sometimes not work.  It is unclear why braces work on some patients and not others.  In general, bracing success has been related to compliance.  If you listen to your COA doctors' recommendation regarding bracewear, then your are less likely to progress.

How many hours should my child wear her back brace?

This is a question that should really be discussed with your COA provider.  There are different types of back braces, and each one has a different recommended wear time.  It is extremely important that you follow the instructions of your physician.  A back brace cannot work if it is not worn.

When do we get to stop wearing a back brace?

In general, bracing is continued until your child is essentially done with growth.  Average age for girls is 14 and boys 16.  Another good guideline is approximately 2 years after a girls' first period.

When do you recommend surgery?

In general, surgery is recommended for adolescent idiopathic scoliosis, when curves continue to worsen.  Once curves get to a certain magnitude (roughly 45-50 degrees), especially in a growing child, these curves will continue to progress.  It is important to remember that the number one goal of surgery is to fuse the spine in the area it is abnormal to prevent the curve from worsening.  To acheive this goal, your surgeon will perform the procedure with as little risk as possible.  Scoliosis surgery is not completely corrective, nor is that the main goal.  In some situations, complete scoliosis correction can be either too risky, or may cause more problems in the future.  

The decision to perform surgery is obviously a major one and needs to be discussed in detail with your COA surgeon.  

What are the major risks of surgery?

There are several major risks of surgery, but at the same time, your COA surgeons use state-of-the-art safety precautions such as robotic-assisted surgery, and spinal navigation surgery, to minimize these risks.  Please refer to "my child is having scoliosis surgery" for further details.

What happens if I refuse surgery?

Your surgeon will never force you or your child to have surgery; rather, he or she may strongly recommend surgery.  The concern with progressive scoliosis is the long-term implications.  At some point, large curves will become symptomatic.  Back pain, and even compression on the lungs can happen.   While your child's 60 degree curve may not be painful at the present moment, it likely will at a later age.   The larger the scoliosis curve, the more challenging it is for your surgeon to correct it.  In addition, the amount of correction will be less the larger the curve becomes.  In addition, an adolescent with a 60 degree curve, in general, is going to have a much faster recovery versus a 40 year old with a 100 degree curve.  The older adult is likely to have more medical problems, and may have a more challenging time taking off work for many months versus an adolescent missing school for 4-6 weeks.

Short-term waiting (6 months, 1 year, etc), may be completely okay in certain scenarios.  If your child wants to finish her sports season prior to surgery, or if you and your child would like to wait until the summer time or holiday time to avoid missing too much school, this is likely just fine.  This is on a case-by-case basis, and will obviously be part of the decision making process by you and your childs' COA surgeon.

Will my child be able to do sport after surgery?

Yes, your child should be able to return to sports after surgery.  Restrictions are greater initially for contact sports (such as football and hockey) versus non-contact sports (such as running, golf and tennis).   Expect to be out of sports between 3-6 months or possibly 1 year after surgery, depending on the complexity of the surgery, the type of sport, and your surgeons' preference.  Certain activities that place extensive forces on the back- such as bungee jumping and jumping out of airplanes are discouraged by most of the COA surgeons.   

Does my child need antibiotics at the dentist after scoliosis surgery?

Your COA surgeon would highly discourage dental cleaning and/or procedures, unless absolutely necessary, at least for the first 3 months after surgery.   Following this time frame, we would recommend antibiotics prior to cleaning for 1 year after surgery to ensure that the spine has fully completed its fusion process.  If your child has a decreased immune system, has Type I Diabetes, then we would recommend antibiotics prior to all dental procedures and cleanings.  It is ultimately up to your childs' pediatrician which antibiotic is appropriate, but we are always available to help if your pediatrician needs to call us.

Will my child "beep" at the airport metal detector?

With newer surveillance systems, it will be evident that there is metal in your back.  Just simply tell the transportation safety authority (TSA) agent at the time of your security screening that you have metal spine implants, and it should not be a problem.

In general, your COA surgeons discourage airplane travel for the first three months after surgery since there are many restrictions we take to ensure that the spine fuses.  In general, your child will not be able to bend, lift, or twist for the first three months following surgery.