If a child has moderate scoliosis and the bones are still growing, the doctor may recommend a brace. Wearing a brace does not cure scoliosis or reverse the curve, but it usually prevents the curve from worsening.
The most common type of brace is made of plastic and is shaped to fit the body. This brace is nearly invisible under clothing, as it fits under the arms and around the rib cage, lower back and hips.
Most scoliosis braces are worn between 13 and 16 hours a day. The effectiveness of a brace increases with the number of hours a day it is worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, the child can remove the brace to participate in sports or other physical activities.
Scoliosis braces are not longer worn when no further changes in height occur. On average, girls complete their growth at the age of 14 and boys at 16, but this varies greatly between individuals.
Surgeons have performed and refined spinal fusion surgery for decades with a high rate of success.
In a spinal fusion, surgeons connect two or more of the bones in the spine, called vertebrae, together so they can’t move independently and then they heal into a single, solid bone. This stops growth completely in the abnormal segment of the spine and prevents the curve from getting worse.
All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. Generally, small pieces of bone are placed into the spaces between the vertebrae to be fused. The bone grows together — similar to when a broken bone heals.
Metal rods are typically used to hold the spine in place until fusion happens. The rods are attached to the spine by screws, hooks, and/or wires. Exactly how much of the spine to fused depends upon the patient’s curve.
Most spine fusion surgeries last from 4 to 8 hours, depending on the size of the patient’s curve and how much of the spine needs to be fused. Some of this time is spent preparing the patient for anesthesia, as well as hooking the patient up to various monitors, and positioning the patient to be as safe and comfortable as possible.
Patients may require spinal fusion surgery because:
- They have curves that can get too large for the brace.
- They’re too old and their spines have finished growing.
- They have a type of scoliosis that can’t be stopped with a brace.
In cases where scoliosis progresses rapidly during early childhood, surgeons can employ one or two expandable rods along the spine that can be lengthened as the child grows. This adjustment, necessary due to the child’s ongoing growth before reaching skeletal maturity, is made every 3 to 6 months.
These scoliosis rods serve as a treatment for severe scoliosis in young children who cannot undergo spinal fusion due to their age. Unlike adults, children under 8 years old continue to experience growth, contributing not only to their height but also expanding their chest and developing their lungs.
Unlike spinal fusion, devices like scoliosis rods are designed to preserve growth. They allow the child to grow until reaching skeletal maturity, after which a more permanent solution like spinal fusion can be considered.
Before the introduction of minimally invasive scoliosis rods, children with scoliosis had to undergo multiple surgeries to adjust rod length as their spines grew. Modern systems have eliminated this requirement. Some advanced growing devices include:
- Magnetically controlled scoliosis rods (MCGR): With MCGR, the scoliosis rods are implanted only once. Subsequently, an external remote controller is used to expand the rods in accordance with the child’s height changes. The rods contain magnets that can be activated by the doctor using a handheld device, enabling lengthening without incisions.
- Growth-Guided Devices: These devices utilize “anchor points” to attach expandable rods to the spine via screws or wires. As the child’s spine matures, the rods stretch in length due to the growth process. While the rods are rigid apart from vertical expansion, they effectively correct spinal curvature while allowing for growth.
- Vertical Expandable Prosthetic Titanium Rib Device (VEPTR): Severe scoliosis in children and adolescents may require VEPTR to facilitate rib expansion as the child grows. Adequate chest expansion is necessary for lung maturation, and VEPTR serves this purpose. It’s important to note that only specific hospitals are equipped to perform VEPTR procedures.
Vertebral body tethering (VBT) is a surgical solution for idiopathic scoliosis in growing children whose condition persists despite bracing. Vertebral body tethering leverages the natural growth of the spine to correct sideways curvatures while allowing ongoing spinal development. Vertebral body tethering can be an alternative to spinal fusion surgery and is recommend if the child:
- Idiopathic scoliosis
- Scoliosis curves that are between 40-65 degrees
- Vertebral bodies of sufficient size to accommodate screws
- At least 10 years old and generally younger than 16 years old
- Have significant growth remaining
- Sanders score of 2-5 or Risser 0-3
In this innovative procedure, metal anchors and a flexible tether are attached to the side of the spine exhibiting outward curvature. In contrast to spinal fusion surgery, which involves attaching metal anchors and rigid rods to both sides of the spine, vertebral body tethering is less invasive.
Surgeons affix metal anchors to the vertebrae on the outwardly curved side of the spine. A flexible cord, or tether, connects these anchors and is placed under tension. As the child continues to grow and their spine elongates, the tether slows down growth on the curved side, allowing the other side of the spine to catch up. Consequently, as the child grows, their spine gradually straightens. The anchors and tether are permanently attached to the child’s spine, unless complications arise.
In comparison to spinal fusion surgery, vertebral body tethering preserve greater mobility and flexibility of the spine. Spinal fusion involves fusing vertebrae into a solid bone, creating an inflexible section of the spine that cannot bend or grow beyond its height at the time of the surgery. The rest of the spine that is not fused has to perform additional work, because it has to compensate for the loss of movement at the fused spine; as a result, the unfused spine wears out more quickly and may lead to degenerative arthritis.
