Treatment options available for children with scoliosis

Q: My granddaughter was diagnosed with a severe case of scoliosis. What is scoliosis, and what treatments are available?

A: Scoliosis is a side-toside curvature of the spine that can occur in about 1 in 300 children. In growing children, curves can progress rapidly, especially during the adolescent growth spurt.

Growth plates, which are compressed, grow more slowly, resulting in progressive wedging of the vertebra and scoliosis progression. Large curves can continue to progress slowly in adulthood, eventually causing problems with quality of life and even breathing.

Typically, braces can be prescribed to treat mild or moderate curves by holding the spine in a corrected position while the spine grows. Bracing may prevent the curve from worsening, but it does not typically straighten the alignment of a curved spine.

For some children, the curvature of their spine is significant, thus the diagnosis of severe scoliosis. Severe curves can be treated with spinal fusion. This reliable and successful procedure, which has been around since the

1960s, prevents the curve from returning.

With spinal fusion, an

8- to 12-inch incision is made over the back, and the muscles are moved out of the way to reach the spine. Screws and rods are attached to the curved area of the spine, and the spine is pulled into a corrected position. Then small joints over the back of the spine are removed, and the bone is roughened with a highspeed burr.

After fusion, however, the spine no longer grows over the area where the spine is fused, and the spine does not move over the area that is fused. In most cases, the unfused area of the spine can compensate, and children have normal function and acceptable spine motion. After a fusion surgery, children are in the hospital for three to four days and could miss about three weeks of school. Most children can return to normal physical activity and play most sports within 12 weeks after surgery.

In rare cases, patients will require a second surgery. Based on research, only about 2% of patients need a second surgery within the two years of the first procedure.

Once a fusion surgery is performed, there is no reason to perform a nonfusion procedure. However, newer surgeries that do not involve fusion are available to treat scoliosis.

The goal of these nonfusion surgeries is to correct the scoliosis but still allow for the spinal growth and motion. However, the long-term results of these procedures are not known.

To date, the risk of needing a second surgery is higher after a nonfusion surgery — up to 10% to 20% chance within two years of the procedure. Two devices approved by the Food and Drug Administration are used for nonfusion spine procedures to treat scoliosis — both through a special humanitarian approval.

While significant advancements have been made to treat childhood scoliosis, early detection and treatment with bracing are always the first choice. For more severe scoliosis, families now have treatment options. Ongoing research and advances in these nonfusion strategies will improve the outcomes and reduce the chance of needing multiple surgeries in the future.

For now, fusion is the most reliable option, but some patients and families may prefer a nonfusion approach to preserve motion and spinal growth, and these safe, FDAapproved options are available now.

— A. Noelle Larson, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Mayo Clinic Q&A is an educational resource and doesn’t replace regular medical care. Email questions to MayoClinic Q&A@mayo.edu. For more information, visit www. mayoclinic.org.

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