Back on Track

Treatments for scoliosis help adolescents at a tender time

A diagnosis of scoliosis can throw a child a curveball. Typically, at age 10 to 15 — just as kids embark on the sensitive years of adolescence — they might notice that one hip appears higher than the other. Or their shoulders or waist might look uneven.

Scoliosis, with its C- or S-shaped curvature of the spine, can be an unwelcome finding, especially for a child on the cusp of adolescence. But it’s important to diagnose scoliosis early, so the condition doesn’t significantly progress, putting kids at risk for pain, physical deformity or lung or heart issues related to the curvature.

More than 7 million people are diagnosed with scoliosis each year, according to the National Scoliosis Foundation. Fortunately, new advancements are improving the options for children and adolescents with pediatric scoliosis.

Correcting the curve

For Chloe Berkich of Itasca, the scoliosis diagnosis came as a surprise. At age 12, during her annual physical, her family practitioner noticed a curve in her spine when he asked her to bend forward, in a routine screening test called the Adams forward bend.

The pediatrician referred Chloe to Shriners Hospitals for Children – Chicago for diagnosis and specialized scoliosis care.

At the time of her 2016 diagnosis, Chloe’s curvature was 37 degrees. Because her growth plates had already closed, she was not a candidate for a back brace, a typical treatment for scoliosis.

Chloe started with a physical therapy program, called the Schroth Method, designed to help children hold their spines straighter. But Chloe’s curvature progressed, causing more stiffness and pain in her back.

“Chloe seemed to be having good success, but when her curve started to change significantly, the therapists couldn’t do anything else,” her mother, Carrie Berkich, says.

A spine curvature of 10 degrees qualifies as scoliosis. For mild cases, doctors usually stick with observation to make sure the curvature doesn’t significantly progress.

People with a curvature of 25 to 40 degrees typically wear a customized brace to prevent further curvature. When the curvature progresses to 45 degrees or higher, they usually need spinal surgery to straighten the spine.

Overall, about 30% of people with scoliosis use a brace, and about 10% of adolescents with scoliosis need surgery, according to Johns Hopkins Medicine.

About 80% of scoliosis cases are idiopathic, meaning of no known origin. Other scoliosis types are due to nervous system problems — such as cerebral palsy or muscular dystrophy — that affect the muscles.

Effective bracing

Bracing is an effective approach for adolescents diagnosed with idiopathic scoliosis, says John Grayhack, MD, pediatric orthopedic surgeon at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Worn under clothes, a brace covers the torso from the armpits to the pelvis.

Previously, patients were instructed to wear a brace for 18 to 23 hours a day. But recent studies show that it’s fine not to wear the brace all day, giving kids a break during school hours. A multi-site study, published in 2013 in the New England Journal of Medicine, showed a success rate of 90% to 93% when individuals wore a brace for 13 hours a day or more.

“We encourage kids to wear it between 13 to 18 hours a day and no more,” Grayhack says. “Studies prove that a brace can work, and if you wear the brace for 18 hours, it works just as well as if you wear it for 24 hours a day. That’s a big improvement.”

Braces can decrease the need for surgery, says Steven Mardjetko, MD, an orthopedic surgeon at Illinois Bone & Joint Institute. “[The study] definitively demonstrated that scoliosis bracing, done the right way, will decrease the need for surgery in children with progressive adolescent idiopathic scoliosis,” he says.

Spinal fusion surgery

Because curvature typically worsens during growth spurts, every three to six months Chloe saw Purnendu Gupta, MD, chief of staff at Chicago Shriners Hospital, for observation.

Three years after diagnosis, when Chloe’s curvature progressed to 56 degrees, Gupta recommended spinal fusion surgery, which involves fusing vertebrae and implanting rods to straighten the spine.

This is a disease that is emotionally scary. But the reality is that we have the opportunity of getting them back to doing everything they did before treatment.”

Spinal fusion surgery corrects the spinal curve and gives individuals adequate space in the chest for the lungs to grow. “The most important reason to do the surgery is to maximize the development of the lungs so they can live long and healthy lives,” Mardjetko says.

As Chloe’s scoliosis progressed, it affected her lung functioning, says her mother, Carrie.

“She was having a hard time with her lungs and breathing right about the time she needed surgery,” Carrie says. “After surgery she was able to breathe normally.”

For Chloe, who is a ballet dancer, her July 2019 surgery was well worth the discomfort. “I noticed a difference in my balance right after surgery. From the first time I stood up, I had good posture and balance, and I didn’t have to try so hard to stay straight anymore,” she says.

New approaches

Surgical advancements have improved spinal fusion surgery.

“We tend to fuse less of the spine, and that’s good because patients are more mobile. There’s less of a longer-term risk of arthritis and back pain,” Grayhack says.

In some instances in younger children, doctors can surgically lengthen expandable growing rods every six months to accommodate the child’s growth.

A newer technology called MAGEC uses an external remote-controlled device to lengthen the magnetically controlled rod as the child grows, reducing the need for frequent surgeries, Gupta says.

In August 2019, the FDA approved The Tether – Vertebral Body Tethering System, which is less invasive and may prevent further curvature, Gupta says. Instead of a rod, a flexible tether is pulled tight along the spine, helping to correct the curvature through the child’s growth.

In this procedure, the spine is not fused, allowing for more movement in the spine, Mardjetko says. “It is a fusionless guided growth technique, altering the growth of the spine across segments to actually correct scoliosis,” he says.

The new treatments provide relief at a critical time for adolescents. Chloe is doing significantly better than she was before her surgery, her mother says, and she’s counting down the minutes to when she is cleared to dance.