At first, the signs can be subtle: a child’s shoulders don’t quite line up, one side of the ribs juts out a bit more than the other, or a parent notices an asymmetrical waist. Scott Nelson, MD, a pediatric orthopedic surgeon at Loma Linda University Children’s Hospital, says these early clues often point to scoliosis, a spinal condition that, if left unchecked, can cause lifelong complications.
“There are several types of scoliosis,” said Nelson. “But adolescent idiopathic scoliosis is the most common. That usually shows up during puberty and affects more girls than boys.”
Doctors use the term idiopathic because the exact cause remains unknown. Unlike congenital scoliosis, which children are born with due to malformed vertebrae, idiopathic scoliosis tends to develop during a child’s growth spurt, usually between ages 10 and 14.
Other forms include early-onset scoliosis, which appears before age 10, and neuromuscular or syndromic scoliosis, often associated with conditions such as cerebral palsy or muscular dystrophy.
Most cases are diagnosed after a parent, teacher, or pediatrician notices the asymmetry. Formal school screenings have become less common, but basic physical observations remain critical.
Scoliosis is confirmed through X-rays, where doctors use a technique called the Cobb angle to measure the degree of spinal curvature. “If it’s under 10 degrees, we call it spinal asymmetry, and that’s not treated,” Nelson said. “Over 10 degrees is when we begin to monitor more closely.”
The frequency of follow-up imaging depends on the child’s age and growth rate. A rapidly growing child with a mild curve might need X-rays every three to six months.
Not every child with scoliosis needs treatment. Mild curves are usually just observed over time. But when the curve reaches between 25 and 40 degrees in a growing child, bracing is often recommended.
“The brace doesn’t correct the curve, it just keeps it from getting worse,” Nelson said. “If we can hold that curve steady until they finish growing, they may never need surgery.”
Bracing typically involves a custom-molded thermoplastic device worn 23 hours a day. Children might wear it for one to three years, depending on when they begin treatment and how much growth they have left.
If the curve exceeds 50 degrees, surgical intervention is usually necessary. The most common procedure, spinal fusion, uses metal rods and screws to stabilize the spine and prevent further curvature. The fused vertebrae become one solid bone over time, halting motion in that segment.
For younger patients, especially those under 10, traditional fusion can limit their growth potential. In those cases, surgeons may use growing rods, which allow the spine to lengthen as the child matures. These rods can be adjusted every few months, sometimes using a magnetic device that eliminates the need for repeated surgeries.
“We want to preserve as much natural function and motion as we can. But the priority is always to prevent progression and long-term complications.”
Some parents turn to physical therapy methods like the Schroth method, which promotes spinal posture and muscle training. While popular online, these techniques lack robust scientific support, Nelson said.
“There’s nothing that proves they don’t help, but there’s nothing conclusive that shows they do,” he said. “The most effective tools we have are still X-rays, braces, and, when needed, surgery.”
Most children are discharged from the hospital within four days and return to school in about a month after a spinal fusion. Full physical activity is typically resumed within six to 12 months.
“In most cases, it’s a one-time surgery. The hardware stays in for life, and the majority of patients don’t need follow-up procedures,” he said. “With the right treatment plan, most kids go on to live completely normal, active lives.”
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