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5 Common Types of Scoliosis: Which Form Does Your Child Have?

5 Common Types of Scoliosis: Which Form Does Your Child Have?

by | Dec 3, 2023 | Scoliosis & Spine

Scoliosis is a common orthopedic condition that affects between 2% to 3% of the population. This abnormal sideways curvature of the spine can range from mild to severe, with varying health impacts. Scoliosis must be monitored until children stop growing, and moderate to severe curves will need corrective treatment. However, different types of scoliosis have different prognoses and may require different types of treatment.

What Is Scoliosis?

Prior to learning about the different forms of scoliosis, it helps to first understand what this condition is and how any form of the disease can affect a child.

Scoliosis happens when a child’s spine curves sideways. Normally, the spine is straight or has a slight S-curve when you look at it from the side — the top of a child’s back may curve out a little bit, and their lower back may curve in slightly.

In children with scoliosis, the spine curves or twists in an S- or C-shape. Mild cases may only limit a child’s flexibility, but severe cases can cause deformities and serious health problems, such as:

  • Arthritis
  • Back pain
  • Breathing problems or other lung issues
  • Heart problems
  • Paralysis
  • Problems walking, standing or doing other physical activities

Whether mild or severe, the form of scoliosis your child has can also play a role in its long-term impacts. Below are five common types of scoliosis.

Idiopathic Scoliosis

Idiopathic scoliosis, also called adolescent idiopathic scoliosis, is the most common type of scoliosis, affecting around 80% of children with scoliosis. It typically shows up at age 10 or later and has no known cause, although there is a genetic connection. About 30% of children with idiopathic scoliosis have a family history of scoliosis.

Despite what many parents or kids may think, carrying a heavy backpack or slouching will not cause scoliosis.
Treatment for this type of scoliosis depends on the severity of your child’s spinal curve, defined as:

  • Mild, less than 20 degrees
  • Moderate, between 25 degrees and 40 degrees
  • Severe, greater than 50 degrees

Regardless of severity, many children with scoliosis benefit from physical therapy (PT). PT helps reduce pain and improve breathing, while also preventing a curve from getting worse.

Children with mild curves may simply need monitoring every six to 12 months to ensure a curve is not getting worse.

Moderate curves may require a child to wear an orthotic back brace daily for months or even years. Braces are usually successful in stopping the curve from progressing to a point of needing surgery.

Severe curves or moderate curves that do not get better with bracing may require spinal surgery. Spinal fusion is the most common type of surgery for severe adolescent idiopathic scoliosis, but some patients may benefit from a newer technique, vertebral body tethering (VBT).

Congenital Scoliosis

Congenital scoliosis is a form of the condition that exists when a child is born. A rare birth defect, congenital scoliosis occurs in only 1 in 10,000 children.

There are several different types of congenital scoliosis, each affecting how the spine curves abnormally in different ways. All can cause serious problems in children’s growth.

Many children with congenital scoliosis are not diagnosed until the problem becomes noticeable later in childhood or during the teenage years.

Unlike idiopathic scoliosis, congenital scoliosis usually cannot be helped by bracing. Children with mild curves will still likely only need monitoring, but those with moderate to severe curves may need surgery.

Neuromuscular Scoliosis

Neuromuscular scoliosis is caused by medical conditions that impact the muscular or neurological systems. These conditions can affect a child’s muscle balance or how the body controls the muscles that support the spine.
Common neuromuscular conditions that lead to scoliosis include:

  • Cerebral palsy
  • Friedreich ataxia
  • Muscular dystrophy, especially Duchenne
  • Myelodysplasia
  • Spina bifida
  • Spinal muscle atrophy
  • Spinal trauma, especially that causing paralysis

These conditions may require children with scoliosis to be in wheelchairs. For those children, wheelchair seats can be modified to improve balance.

Bracing may also help many patients with neuromuscular scoliosis, but it will not stop the progression of curves. Surgery may be an option, depending on the underlying medical condition and other factors.

Early-Onset Scoliosis

Early-onset scoliosis develops before age 10. In most cases, early-onset scoliosis is idiopathic. Treatment is crucial for preventing breathing problems or deformities later in life.

Infants and children younger than age 2 who have early-onset scoliosis may need to wear a cast for two to three months at a time. In children this young, casting is often easier than bracing.

If a very young child’s scoliosis is severe, they may need a special type of surgery that involves attaching a magnetic rod to the spine. The rod can be lengthened as the child gets older, at which point they usually have spinal fusion surgery.

Syndromic Scoliosis

This type of scoliosis is very rare and develops as part of another condition, such as:

  • A connective tissue disorder, such as Marfan or Ehlers-Danlos syndrome
  • Beale’s syndrome
  • Down syndrome
  • Prader-Willi syndrome
  • Rett syndrome

Treatment options for syndromic scoliosis depend on the severity and the other health conditions involved.

Could Your Child Have Scoliosis?

Children are usually screened for scoliosis during their annual wellness exams, and they may be screened at other times, such as during school health screenings.

However, children grow quickly, so it’s important for parents to know the symptoms of scoliosis. Be on the lookout for signs such as:

  • Back pain
  • One shoulder blade that sticks out more than the other
  • One shoulder, hip bone or rib cage that seems higher than the other
  • Rounded shoulders
  • The sense that your child’s head is no longer directly centered above the pelvis
  • A sunken chest

Call your child’s pediatrician if your child experiences any of these symptoms or if you notice an unusual spinal curve when your child bends forward to touch their toes. Getting treatment early, no matter which type of scoliosis your child has, often leads to more successful outcomes.

If your child has been diagnosed with scoliosis, the Scottish Rite Center for Excellence in Spine is here to help. Schedule an appointment to discuss scoliosis care.

A Shared Passion to Protect and Serve

A Shared Passion to Protect and Serve

by | Oct 25, 2023 | Scoliosis & Spine

Published in Rite Up, 2023 – Issue 3. 
 
Last summer, the Inpatient Unit at Scottish Rite for Children had extra security and cuteness overload in the form of a 4-year-old patient lovingly referred to as Policeman Joseph. Donning a police vest, badge, walkie-talkie and binoculars, Joseph, of Gonzales, Louisiana, made daily rounds to keep his fellow patients safe. “He’s got a huge personality stuffed inside a little body,” says Randi, his mother.
 
Joseph has congenital kyphoscoliosis. In utero, his vertebrae formed differently, which caused both kyphosis, or an outward spinal curve, and scoliosis, a sideways curve. At age 2, Joseph was referred to Scottish Rite for Children where he received expert care from pediatric orthopedic surgeon Amy L. McIntosh, M.D.

When Dr. McIntosh evaluated Joseph, his curve measured more than 80°, which was beyond the point when surgery is recommended. “For young children who have severe congenital curves, bracing or casting doesn’t help because of the abnormal vertebrae,” Dr. McIntosh says. “You have to wait until they’re big enough to surgically fit an implant in them.” Dr. McIntosh monitored Joseph until he was 4. When his curve reached 100°, she recommended six weeks of halo-gravity traction followed by surgery.

Halo-gravity traction gently stretches and straightens a significantly curved spine in a slow, safe manner. “It’s like taking a spring that’s coiled up and slowly uncoiling it over time,” Dr. McIntosh says. While Joseph was under anesthesia, Dr. McIntosh applied the halo by attaching it to his skull. “I didn’t even feel it,” Joseph says. “It was super magic!” With the help of his care team, Joseph could fasten his halo to a traction device on a pulley system that connected to his walker, wheelchair or bed.
 
While in traction, Joseph participated in therapeutic recreation, physical therapy (PT) and fun activities in Child Life. “He made friends with everyone, especially the security officers,” Randi says, “and he loved growing his muscles in PT, so he could keep his new friends safe. Scottish Rite became our second family, a home away from home.”
 
When traction was complete, Joseph underwent surgery. Dr. McIntosh inserted a magnetic growing rod, also known as the MAGEC® System, on one side of his spine and a sliding traditional growing rod on the other side. After a successful procedure, his curve measured 42° — a correction of almost 60%. “He got almost two inches taller,” Dr. McIntosh says.

 Going forward, the rods in Joseph’s back will be lengthened as he grows. Rather than undergoing multiple surgeries, an external magnetic device will be used to locate the magnet inside the rod to lengthen it. “The magnetic rod acts as a motor to drive the traditional rod that will slide,” Dr. McIntosh says. This hybrid construct will control the correction of Joseph’s spine until he stops growing and ultimately receives a definitive spinal surgery. “Joseph’s care has been top-notch,” Randi says. “Dr. McIntosh is absolutely the best, a true godsend.”
 
On his last day at Scottish Rite, Policeman Joseph made his final rounds, protecting the kids and doing a celebratory safety dance on his way out.
 
Read the full issue.

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

by | Oct 24, 2023 | Scoliosis & Spine

We are honored to announce the appointment of Megan E. Johnson, M.D., as program director for the Dorothy & Bryant Edwards Fellowship in Pediatric Orthopedics and Scoliosis at Scottish Rite for Children. The Edwards fellowship is one of the oldest and largest fellowships in the country and has an alumni of nearly 200 surgeons.  
 
With this new appointment, Dr. Johnson will be responsible for attracting outstanding candidates from diverse backgrounds and training them to be skilled clinicians and surgeons. Dr. Johnson will ensure ongoing maintenance of a high-quality educational curriculum for our fellows and provide leadership and direction to our orthopedic faculty who take part in education. She will have a key role in ensuring our curriculum is undergoing needed innovation through regular program evaluation and quality improvement.
 
Dr. Johnson received her medical degree and completed residency training at Vanderbilt University in Nashville, Tennessee. She completed her pediatric orthopedic fellowship at Scottish Rite for Children in 2015, and following her fellowship, she returned to Vanderbilt University Medical Center. She joined the Scottish Rite for Children staff in 2020 as a pediatric orthopedic surgeon. Her clinical practice focuses on spine deformity in the pediatric population. She also treats patients with spina bifida, not only for their spine conditions but also for lower extremity issues. Dr. Johnson also serves as the Medical Director of Ambulatory Care and is an assistant professor of Orthopaedic Surgery at UT Southwestern Medical Center. 
 
“Dr. Johnson is an excellent clinician in the outpatient, inpatient and surgical setting and is an extremely talented surgeon who takes on both the straightforward as well as the complex deformities,” says Chief of Staff Daniel J. Sucato, M.D., M.S. “Not only is she a great leader, but she also has a natural ability to educate and is one of the favorites of our fellows to work with in the operating room and clinics.”
 
Dr. Johnson succeeds Dr. Sucato, who has served as program director of the Pediatric Orthopedic Surgery Fellowship program for the past 10 years. Dr. Sucato will remain Chief of Staff of Scottish Rite for Children as well as the director of Scottish Rite for Children’s Center for Excellence in Spine.

Share Your Story: Connor’s Comeback

Share Your Story: Connor’s Comeback

by | Sep 1, 2023 | Scoliosis & Spine

Meet Connor, a strong and determined athlete whose journey with Scottish Rite for Children began when he was just 10 years old. His scoliosis was first noticed by his mom when she noticed his clothes hung differently. She asked his pediatrician, who referred them to Scottish Rite spine experts. Visiting Chief of Staff Dr. Dan Sucato, Connor’s scoliosis was identified as a 30-degree curve at the time, prompting regular monitoring every six months.

As Connor grew and got more into school sports, his scoliosis curve increased too. His curve was 60 degrees, causing him discomfort. Frustrated with the limitations his condition imposed, Connor decided at 15 that he was ready for a change and opted for surgery.

Last summer, Connor underwent spinal fusion surgery. He spent three nights recovering in our inpatient unit. The support he received from our medical team eased his worries, making him feel at ease about the surgery. His quick recovery amazed everyone, allowing him to celebrate his 16th birthday with friends just two weeks later.

The transformation was remarkable. His shoulders were even, and his T-shirts fit properly. His dedication to recuperation and determination to regain his active lifestyle paid off. With his scoliosis corrected, Connor joyfully rejoined the high school junior varsity football team and played in his first game after taking a year off.

But it wasn’t just the surgery. Connor found comfort at Scottish Rite, from our yummy popcorn to our caring staff who he says felt like family to him. Dr. Sucato didn’t just fix his scoliosis; he brought back normalcy. With no more limping due to his hip pain, Connor got his life back. He’s loving football, golf, hiking and rafting. Watching sports and eating out with friends now brings him joy, as he embraces his new freedom without limitations.

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Bracing for Scoliosis

Bracing for Scoliosis

by | Jun 16, 2023 | Scoliosis & Spine

At Scottish Rite for Children, we are committed to providing individualized patient care to every child. As one of the most common conditions our experts treat, scoliosis can present in many forms. Depending on the child and the severity of their curve, the plan for treatment can vary. 

Bracing is a treatment option for patients whose curve is smaller to moderate. It is during a patient’s adolescent years that he or she is growing the most, which means their curve can also grow. The ultimate goal of a brace is to prevent the curve from getting larger to ultimately avoid the need for surgery in the future. However, a brace does not cure scoliosis.

At Scottish Rite, there are different types of custom-made braces for patients. Below are the most common:

TLSO (Boston) Brace

  • TLSO stands for thoracolumbosacral orthosis.
  • For a child whose curve ranges from 25 to 40 degrees and is located in the middle to lower back.
  • This brace is worn during the day. Depending on the child’s curve, the doctor will prescribe the number of hours he or she should wear the brace.
  • Custom made for every child, the brace starts at the armpit and comes down to the pelvic bone.
  • The brace is worn under clothing.
  • Patients are able to remain active while wearing the brace. However, you must check with your doctor on any restrictions.

Providence (nighttime) Brace

  • Used for smaller curves located lower on the spine.
  • Most effective for patients who still have a good amount of growing left.
  • Because of its structure, this brace can only be worn at night.
  • The brace goes up one side of the body, essentially pushing the curve the opposite way.
  • The brace holds the spine in the correct straight position while growing during the night.
  • It is custom made for each child.
  • It doesn’t hurt, but if uncomfortable, it can be refitted.
  • Within a few days, patients say they are used to sleeping while wearing the brace.

Learn more about scoliosis bracing. 

Gracee Gets Back in the Game After The Tether™ Spinal Surgery — the First at Scottish Rite

Gracee Gets Back in the Game After The Tether™ Spinal Surgery — the First at Scottish Rite

by | Jun 1, 2023 | Scoliosis & Spine

Cover story previously published in Rite Up, 2023 – Issue 1.
by Kristi Shewmaker

Gracee never imagined that one day she would play basketball in the Dallas Mavericks® practice gym, much less play one-on-one against her 6’5” pediatric orthopedic surgeon. As a 15-year-old high school varsity basketball player of Tuscola, she also never imagined that three months before that, she would be the first patient at Scottish Rite for Children to receive The Tether™ Vertebral Body Tethering System, a surgically implanted spinal device that is used to treat scoliosis.

Gracee grew up with basketball. “As a little girl, she went to the gym a lot because we were in the gym a lot,” says Carla, her mother. Gracee’s father, Hunter, is the high school varsity girls basketball coach. Gracee watched him coach her older sister before playing herself.

Gracee started playing competitive basketball in second grade. “We sent letters home to the girls in her class saying that we were going to meet one day a week to skill and drill,” Hunter says, “and it grew from there.” Throughout the years, Hunter coached Gracee and her team in various leagues. In middle school, Gracee joined her school team. In high school, Gracee started on the varsity team with some of the same girls that she has played with since second grade. “What I love most about basketball is the friendships that come with it,” Gracee says.

The summer before her freshman year, Gracee was seeing a chiropractor for an issue with her hip flexor, and Hunter mentioned that she had scoliosis during the appointment. A school nurse had noticed it during a routine screening when Gracee was in elementary school. Her curve was less than 10°, so her pediatrician had been monitoring it. “When she laid down on the chiropractor’s table, and I saw her back,” Hunter says, “I was like, ‘Oh my gosh!’ We didn’t realize to what degree the curve had gotten.”

Hunter contacted Scottish Rite for Children for help, and there, Gracee was diagnosed with adolescent idiopathic scoliosis. This condition occurs in patients ages 10 to 18, and the cause is unknown. Her curve measured 42°. “I was shocked,” Gracee says. “I didn’t think it would be that bad.”

Initially, Gracee wore a brace to prevent further progression and to try to avoid surgery. However, within months, her curve progressed to more than 50°, which experts call the surgical threshold — the point when surgery is recommended to stop a curve from getting larger. “In a certain subset of kids wearing their braces, the curve still progresses,” says Jaysson T. Brooks, M.D., pediatric orthopedic surgeon. “They have so much growth potential left, their spine overpowers the brace.”

When Gracee and her family first met Dr. Brooks, they began discussing treatment options in anticipation of the need for surgery. Dr. Brooks presented two surgical options, including spinal fusion, which he calls “the gold standard treatment,” and The Tether™, a new non-fusion surgical device he had used previously to treat scoliosis but had not been used at Scottish Rite.

In a spinal fusion, screws are inserted into channels of bone surrounding the spinal canal. Two rods are secured into the back of the screws with set caps and tightened with a torque wrench. Bone graft is placed along the implant to help the vertebrae fuse together. This procedure stops the growth in the previously curved part of the spine and prevents the curve from coming back.

When using a tether, a flexible cord is attached with screws to the vertebrae on the side of the spine that curves outward, which is also known as the convexity of the curve. The tether slows the growth on the outward side of the curve while allowing the inward side of the spine to continue growing. During surgery, the flexible cord is tensioned, which corrects the curve to some degree. As a child grows, the spine grows straighter because the tether guides it into the correct alignment. The Tether™ is a non-fusion implant that allows children to maintain the majority of their natural spine flexibility
 
“Gracee was a good candidate for this procedure because her curve is flexible, and she was still really young from a bone standpoint, or skeletal maturity,” Dr. Brooks says. “The younger your skeleton is, the higher chance you have of getting taller, and using a tether requires you to be able to grow taller because it capitalizes on that growth.”
 
Over several appointments, Dr. Brooks discussed the pros and cons of each surgery, the difference in incisions, how X-rays look when rods versus a tether are attached to the spine, and the potential downsides and risks. “He did a really good job explaining the difference between the two,” Gracee says. “He also did a really good job of making me feel calmer.”
 
“There wasn’t a lot of anxiety on our part about which way to go,” Hunter says. “In my mind, vertebrae are meant to be flexible. If you can keep it the way God designed it, I think you’re better off. Obviously, there are times when the fusion is the only answer, but with this being another option, we wanted to try it.”
 
Gracee’s family chose this device because they wanted to maintain the overall flexibility of her spine as well as endure a shorter recovery period, so that Gracee could get back to playing basketball as quickly as possible.
 
“They are very intelligent and very pragmatic to approach a procedure that is this new and say, ‘I think this is going to be the right thing for my daughter,’” Dr. Brooks says. “They were mature enough as a family to say, ‘we’re okay with the potential consequences, but we think that the benefits outweigh the risks.’ You couldn’t have asked for a better family to be the first family for The Tether™ at Scottish Rite.”
In April of 2022, Gracee underwent surgery. “I wasn’t that nervous going into it,” Gracee says. “When I got out, I was excited to finally be good. I was excited about it.”
 
“The whole time, I felt like she was in very good hands,” Carla says. “Dr. Brooks’ knowledge is one thing, but he is very compassionate and caring as well. I truly felt like he loved my child.”

Two weeks later, Gracee went back to school. After six weeks, she played her first post-surgery game, and after three months, she found herself at the Dallas Mavericks® practice gym playing basketball with Dr. Brooks.

“It was a really cool experience,” Gracee says. “Dr. Brooks did pretty good.”

The feeling was mutual for Dr. Brooks. “It was a special opportunity for sure,” Dr. Brooks says. “I was pretty good at basketball in high school, but I’m super out of shape now. The only thing I had to my advantage was my height. Where she beat me in speed, I used my height.”
 
Gracee has played shooting guard for as long as she can remember. Hunter explains that she shoots in the 40% range from the three-point line. “Gracee’s a good shooter because she’s up at the gym at 5:00 or 5:30, three or four mornings a week working on her shots,” Hunter says. “Our basketball program is highly competitive. They’re ranked No. 2 in the state.”
 
In December, Gracee’s team won the Whataburger® Basketball Tournament, an invitation-only tournament in Fort Worth. When it was over, five players out of approximately 160 girls were chosen for the alltournament team. Gracee was one of the five.
 
“Going from being on a surgery table in April to being able to do that in December is just phenomenal,” Hunter says. “Gracee’s always been a spunky kid. There wasn’t much spunk a year ago, but we’re seeing it come back.”

Today, Hunter says that they have no regrets about choosing tethering, but he knows that it is still early. During surgery, Gracee’s spine was corrected to a little more than 30°. The goal is that the tether will continue to straighten her spine as she grows.

“If Gracee had walked into my clinic with a 30° curve, she would not have gotten surgery because 30° isn’t big enough,” Dr. Brooks says. “In the end, if nothing changes, it’s still a win because she has a curve that is stable. There are lots of kids walking around with 30° curves who are living full, successful lives.”

Hunter says that they would be happy if her curve stayed where it is and ecstatic if it improves even more. “We’re just fortunate that we’re talking about a scoliosis curve that is manageable,” Hunter says. “When you see what other families at Scottish Rite are dealing with and the care that you see being administered to them, it’s as close to heaven on earth as you think you’ll ever see.”
 
“Everyone works so hard to make the kids at Scottish Rite feel at home, to make me feel at home,” Gracee says. “I wasn’t scared to be the first kid at Scottish Rite to get The Tether™. I like being groundbreaking. I like being the first.”
 
“And, our experience at Scottish Rite,” Hunter says, “has been nothing but first-class.”

Read the full issue.