Adolescent & juvenile scoliosis fundamentals
In scoliosis, the spine curves from side to side. In most cases, the cause is unknown. Both boys and girls develop scoliosis, but girls are four times more likely to require surgery than boys are.
The condition develops gradually, typically between the ages of 10 and 16, and may progress during your child's growth spurt years. Scoliosis is painless and easy to miss, but can become apparent during a routine physical exam. Adolescents are always screened for scoliosis, whether by a school nurse or the family doctor.
Diagnosis involves a look at medical and family history, and a physical and neurological exam. If a curve is detected, X-rays are used to pinpoint the location, extent and degree of curvature.
What are the symptoms?
- Uneven shoulders or waistline
- One or both shoulder blades sticking out
- Leaning slightly to one side
- A hump on one side of the back
What are my child's treatment options?
Treatment depends on your child's age, bone maturity and the degree and pattern of the curve.
Bracing is used to temporarily halt the worsening of the curve during a growth spurt. The braces are lightweight and typically only need to be worn at night.
If the curve is more than 45 degrees, surgery is the only permanent solution. The goal of surgery is to make the spine straighter. The surgeon fuses the bones of the spine together with the help of bone grafts and uses metallic implants to strengthen that bond.
In some cases, surgeons use a less invasive technique. Guided by a thin, telescope-like instrument called an endoscope, they can place metal implants and bone grafts in the spine through small incisions in the abdomen and chest. With this approach, the incision is shorter, recovery is easier, and most patients can leave the hospital after two or three days.
What are the risks of surgery? Is the surgery safe?
Risks include nerve injury, infection and bleeding.
How does my child prepare for surgery?
- Complete any pre-operative tests or lab work prescribed by your child's doctor.
- Do not allow your child to take aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call your doctor's office to verify the surgery time.
What should I do the night before surgery?
Do not allow your child to eat or drink anything after midnight.
What does my child need to do the day of surgery?
- If your child currently takes any medications, please check with the doctor's office before taking them.
- Do not allow your child to wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
What happens after surgery?
Ask your surgeon for complete post-operative instructions.
Surgery immediately makes the spine straighter, so there is usually no need for bracing afterward. The surgery will permanently stiffen the spine, but mobility and function will not usually be affected.
How long is the recovery period after surgery?
After six weeks of recovery, the child may return to school, then to walking-level activities for three months. The child may return to recreational activities and sports as the physician advises. Patients who undergo surgery typically must wait one year before returning to sports.
What is the rehab after surgery?
Rehabilitation involves a gradual return to walking-level activities. The child may swim and return to school after six weeks. Typically, no physical therapy is needed.
How will my child manage at home during recovery from the procedure?
Patients can resume normal activity at home. They may take showers five days after the procedure.
How frequently should I schedule follow up appointments with my child's doctor following surgery?
The child's first post-operative visit typically takes place four to six weeks after the procedure. A second appointment takes place three months after the procedure.
What are the CCF physician credentials?
All doctors at The Cleveland Clinic Department of Orthopaedic Surgery are board-certified or board-eligible in orthopaedic surgery. In addition, our surgeons have subspecialty training and years of experience in pediatric surgery.
All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216.444.2606 or toll free 800.223.2273, ext. 4-2606, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).
What clinical trials and orthopaedic research are being conducted at CCF on the procedure?
Researchers at the Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of The Cleveland Clinic's 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic's personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life.