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Scoliosis

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Scoliosis is a condition where the spine curves and twists to the side, rather than maintaining it's natural straight alignment. The spinal curve typically develops over time. With scoliosis, a child may have a hump on their back, an uneven shoulder, or one side of their chest may appear larger. These physical changes are related to the twisting of the ribs and spine. It is important for your child to see a doctor as this condition will get worse without treatment. 

What is scoliosis?

Scoliosis is a condition where the spine curves sideways, often developing in children and adolescents during growth spurts. At Texas Children’s Hospital, our dedicated team of pediatric specialists provides comprehensive care for scoliosis, from early diagnosis and monitoring to advanced treatments like bracing and surgery.

Understanding the signs of scoliosis — such as uneven shoulders or hips and abnormal spinal curvature — is crucial for timely treatment, which can help prevent further complications as children grow. Our pediatric-focused scoliosis program is tailored to meet the unique needs of children and teens, ensuring the best possible outcomes. Learn more about scoliosis symptoms, treatment options and how Texas Children’s supports children with scoliosis.

In this blog:

Scoliosis in children: When does scoliosis develop?

When children have scoliosis, the spine usually develops an abnormal curve during their growth years. Pediatric scoliosis often worsens as children grow, which makes early detection and treatment essential.

Signs of scoliosis in children may include uneven shoulders, one hip higher than the other or a visible curve in the back. These physical changes are related to the twisting of the ribs and spine. It’s important for your child to see a doctor as early as possible. Scoliosis will likely worsen without treatment, and the earlier your child sees a doctor, the more treatment options they may have.

Scoliosis causes and risk factors

Doctors don’t know for sure what causes the most common form of scoliosis. Other forms of scoliosis may be caused by:

  • Certain types of chest or spine surgery
  • Congenital conditions that impact the spine
  • Neuromuscular conditions, such as cerebral palsy or muscular dystrophy
  • Spinal cord conditions

Girls are more likely to develop scoliosis than boys and having a family history puts your child at higher risk. Symptoms often begin around 10 years old.

Scoliosis signs and symptoms

Let your child’s pediatrician know if you notice any of the following in your child:

  • Posture changes
  • Uneven shoulders or one shoulder blade that looks larger than the other
  • Uneven waist
  • One hip higher than the other
  • One side of the rib cage pushing forward or one side of the back pushing out when bending

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Types of scoliosis

There are three types of scoliosis: idiopathic, congenital and neuromuscular scoliosis.

  • Congenital scoliosis: This type of scoliosis is present at birth. It usually worsens as your child grows. Your doctor may suggest surgery to prevent the curve from worsening and causing other health problems.
  • Idiopathic scoliosis: Idiopathic means that the cause of scoliosis is unknown. However, it tends to run in families and isn’t present at birth. Idiopathic scoliosis occurs more often in girls than in boys and usually worsens during the growing years (ages 11 to 15). While it can’t be prevented, the curve can be controlled with treatments such as bracing and/or surgery.  
  • Neuromuscular scoliosis: Scoliosis can also develop in children or young adults with other diagnoses such as cerebral palsy, spina bifida and other conditions involving the nerves and muscles. Some of these diseases weaken the muscles around the spine, and other conditions affect the spinal cord causing the spine to curve. Surgery is sometimes the best treatment, but it depends on multiple factors.

How to know if your child has scoliosis: Diagnosis and tests

To accurately diagnose scoliosis, your child’s doctor will take X-rays of the spine. The curve can affect the lower (lumbar) and/or the upper (thoracic) area of the spine. If the X-ray shows a curve, your child’s doctor will measure the curve in degrees. An MRI or CT scan of the spine may also be recommended.

Scoliosis treatment and care

The degree of the curve, the type of curve and your child’s age will help determine the type of treatment recommended. Based on these findings, your child’s doctor will discuss treatment options. Treatment may include observation, bracing, surgery or a combination of all three. 

Bracing and other conservative treatments for scoliosis

In growing children with a moderate curve, a brace may be used to slow or stop the scoliosis from progressing. These braces are custom made and help prevent the curve from worsening. The brace is designed to be worn 18 hours a day and is about 70% effective in avoiding surgery. Physical therapy for scoliosis, called the Schroth program, may also be recommended.

In very young children who may be too small for a brace, a special casting technique called Mehta casting can be used to control a spinal deformity.  The cast is usually applied in the operating room. The cast is put around the trunk of the body and is usually changed every 3 months until the child is big enough for a brace.

Scoliosis surgery

Surgery is generally recommended for curves of more than 45–50 degrees. Children who are diagnosed early (7–8 years old or younger) have a lot of growing to do. The goal of surgery in this age group is to control the scoliosis while allowing the spine to continue to grow.

The most common surgery is the MAGEC® rod system, an innovative technology that uses a magnetically driven screw mechanism to “grow” the rod as the child grows. The rods are connected to the spine at the upper and lower ends of the curve. This system allows the rod to be adjusted in the office with a special magnet instead of in the operating room, reducing the number of surgeries needed.

Another surgical option for patients with a moderate to significant spinal curve who aren’t finished growing is called vertebral body tethering (VBT). VBT uses a tether that is pulled tight along the spine and, as the patient grows, the tether helps the spine straighten.

For older children, your child’s doctor may recommend spinal fusion surgery. With this option, the spine is fused permanently to reduce pain, increase stability and prevent the curve from worsening.

Where to find scoliosis treatment

At Texas Children’s, doctors treat many children with both routine and complex spine conditions in our Scoliosis and Spinal Deformity Program. They work closely with families to create a plan that fits your child’s needs and helps them grow and stay healthy.

Frequently asked questions about scoliosis

It’s always advised to talk with your child’s doctor about the best options for care. Chiropractic care is unlikely to improve spinal curvature. It may help to relieve back pain that can happen in children with severe curves.

Most often, scoliosis doesn’t cause pain, especially if the curve is mild or moderate. Children will more severe curves may have back pain. Physical therapy can help relieve back pain.

While some studies have suggested genetic links to scoliosis, no specific genetic markers have been identified. Scoliosis is more likely to run in families, which might indicate a genetic, lifestyle or environmental link.

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