Adolescent idiopathic scoliosis (AIS) is a condition where the spine, which should normally be straight, starts to curve sideways in an “S” or “C” shape. This condition usually appears in children between the ages of 10 and 18, which is why it’s called “adolescent.”

The term “idiopathic” means that the cause of the scoliosis isn’t known. It’s not due to an injury, disease, or other known factor. It’s just something that happens as the child grows. In most cases, the curve is mild and doesn’t cause any problems, but sometimes it can become more severe, leading to noticeable changes in posture, like uneven shoulders or hips, or even discomfort or pain.

Doctors often detect AIS during routine check-ups, where they might notice the spine looks curved, a shoulder blade more prominent on one side, or the waist may look asymmetrical. X-rays are typically required to see how severe the curve is. If the curve is small, A/Prof Buckland may just monitor it as the child grows. If the curve is more significant, a brace might be recommended in order to prevent the curve from getting worse or, less commonly, surgery to straighten the spine.

It’s important to know that AIS doesn’t often cause serious health issues, and most people with AIS live normal, happy, active lives.

Although the exact cause of AIS isn’t known, there are several risk factors that can increase the likelihood of developing the condition:

While the exact cause of Adolescent Idiopathic Scoliosis remains unknown, a combination of genetic predisposition, growth factors, and possibly other environmental or biological influences are believed to contribute to its development. Understanding these risk factors can help in early detection and management of the condition, especially in those who are at higher risk. Regular monitoring during growth spurts is important for children with known risk factors, particularly if there is a family history of scoliosis.

The treatment for Adolescent Idiopathic Scoliosis (AIS) depends on several factors, including the severity of the spinal curve, the age of the patient, and whether the curve is getting worse. Here’s an overview of the common treatment options:

Observation

Who it’s for: Children or teens with a mild curve (typically less than 20 degrees) and who are still growing.

What it involves: Regular check-ups every 4 to 6 months to monitor the curve. A/Prof Buckland will usually take X-rays to see if the curve is changing as the child grows.

Bracing

Who it’s for: Children or teens with a moderate curve (usually between 20 and 40 degrees) who are still growing.

What it involves: Wearing a back brace to prevent the curve from getting worse. The brace won’t straighten the spine, but it can stop the curve from progressing. It’s usually worn for most of the day and night, depending on the type of brace.

How it works: The brace is custom-made and fits snugly around the torso. It applies pressure to the curve to keep it from worsening as the child grows.

Surgery

Who it’s for: Children or teens with a severe curve (typically more than 40-50 degrees) or if the curve is worsening rapidly.

What it involves: The most common surgical procedure is spinal fusion, where A/Prof Buckland straightens the spine as much as possible and then fuses the bones together using metal rods, screws, and bone grafts. The rods help hold the spine in a straighter position while the bones heal and fuse together.

Post-surgery: After surgery, the patient does not typically need to wear a brace, and physical therapy will be recommended to help with recovery. Specific postoperative protocols will be discussed, and written information provided by A/Prof Buckland and his treating team.

Physical Therapy and Exercise

Who it’s for: Can be recommended for individuals with AIS, whether they are undergoing other treatments or not.

What it involves: Physical therapy can help improve posture, strengthen muscles around the spine, and improve flexibility. While it doesn’t cure scoliosis, it can be beneficial for overall back health and comfort.

Alternative Treatments

Who it’s for: Some people explore options like chiropractic care, yoga, or acupuncture. Currently there is a lack of evidence to support these therapies in treatment of scoliosis. It is important not to use alternative treatments in isolation, however these may be used in combination with proven treatments that can be discussed with A/Prof Buckland and his treating team.

What it involves: These treatments may provide relief from discomfort or improve overall well-being, but they haven’t been proven to stop or correct the curvature of the spine in AIS.

Monitoring

Both during, and after treatment, ongoing monitoring is usually necessary to ensure the curve doesn’t worsen, especially during periods of rapid growth, and even when growth has ceased.

The goal of treatment is to prevent the curve from getting worse and to minimize any physical and emotional impact on the adolescent’s life. Most individuals with AIS go on to live normal, active lives, with the condition being well-managed through these various approaches. A specific tailored approach to scoliosis treatment is provided by A/Prof Buckland and his treating team.

Bracing for Scoliosis

Bracing is a common non-surgical treatment for children with scoliosis, particularly when the spinal curve is moderate (typically between 20 and 40 degrees) and the child is still growing. The main goal of bracing is to prevent the scoliosis curve from getting worse as the child grows.

How Bracing Works

• Custom-Made Braces: The brace is custom-made for each child, designed to fit snugly around their torso. It’s usually made of plastic and is designed to be as lightweight and discreet as possible.
• Pressure Application: The brace works by applying pressure to the curve in the spine and surrounding rib cage. This pressure is meant to hold the spine in a straighter position and prevent the curve from worsening as the child grows. The brace doesn’t usually correct the curve that’s already there, but it aims to stop further progression.
• Wearing Schedule: The child is typically required to wear the brace for most of the day and night, often for 18 to 23 hours a day. The exact number of hours can vary depending on the severity of the curve and the type of brace used. The brace can usually be taken off for activities like sports or showering, but should be worn while sleeping.

Types of Braces

• Thoracolumbosacral Orthosis (TLSO): The most common type of brace, which covers the torso from under the arms down to the hips. It’s often called the “Boston brace.”
• Milwaukee Brace: An older type of brace that includes a neck ring and extends higher than the TLSO. This brace is largely historical, and rarely used currently.
• Nighttime Braces: These are worn only while sleeping. They apply more pressure than a daytime brace but are only worn for about 8-10 hours. These braces are typically used later in treatment when the amount of growth remaining is minimal.

Importance of Brace Compliance

Compliance refers to how well the child follows A/Prof Buckland’s instructions for wearing the brace, including the number of hours per day they wear it. Compliance is crucial for several reasons:

• Effectiveness: The effectiveness of the brace in stopping the curve from worsening is directly related to how long and how consistently the brace is worn. If the child doesn’t wear the brace as prescribed, the spine might continue to curve, potentially leading to the need for surgery.
• Growth Periods: Children grow rapidly during adolescence, and this is when the curve can worsen quickly. Consistent bracing during these growth periods is essential to keep the spine as straight as possible and prevent progression.
• Avoiding Surgery: In most cases, successful bracing can help a child avoid the need for spinal surgery. If the brace is not worn as recommended, and the curve worsens, surgery might become necessary.

Challenges with Compliance

• Discomfort: Wearing a brace can be uncomfortable, especially during hot weather or physical activities. It can also be awkward for the child, as the brace may be noticeable under clothing.
• Social Concerns: Adolescence is a time when fitting in with peers is important, and wearing a brace can make a child feel self-conscious. This can lead to reluctance to wear the brace as prescribed.

Support and Encouragement

• Education: Educating the child and their family about the importance of wearing the brace and how it helps can improve compliance.
• Support Groups: Connecting with other children and families going through similar experiences can provide emotional support and practical tips for making bracing easier.
• Positive Reinforcement: Encouraging the child and celebrating milestones in their treatment can help keep them motivated to stick with the bracing regimen.

In summary, bracing is a critical tool in managing scoliosis in children. For it to be effective, consistent use is key, and support from family, healthcare providers, and peers can make a big difference in helping the child stick with the treatment.

Surgery for Scoliosis

Surgery for scoliosis, specifically spinal fusion surgery, is typically performed when the spinal curve is severe or progressing rapidly, and non-surgical treatments like bracing are not effective in stopping the curve from worsening. Here are the main reasons why surgery might be recommended for scoliosis:

Preventing Further Curve Progression

Severe Curves: When the spinal curve reaches a certain degree (typically over 40-50 degrees), there is a higher risk that it will continue to worsen, even after the child stops growing. Surgery is often recommended to prevent the curve from getting worse, which could lead to more serious health issues over time.

Improving Appearance and Posture

Cosmetic Concerns: A severe spinal curve can cause noticeable physical deformities, such as uneven shoulders, prominent ribs, or a tilted waist. Surgery can help reduce these deformities, improving the overall appearance and posture of the patient.

Psychosocial Impact: Adolescents, in particular, may experience self-esteem issues or social difficulties due to the visible effects of scoliosis. Surgery can help address these concerns by making the spine straighter.

Reducing Pain and Discomfort

Chronic Pain: While not all cases of scoliosis cause pain, many individuals with severe curves experience chronic back pain or discomfort. Surgery can help alleviate pain caused by the abnormal curvature, particularly if it is due to muscle fatigue or nerve compression.

Breathing Issues: In very severe cases, scoliosis can affect lung function by compressing the chest cavity. Surgery can help prevent or relieve these breathing difficulties by straightening the spine.

Preventing Long-Term Health Issues

Heart and Lung Problems: In rare cases of very severe scoliosis, the curve can become so pronounced that it affects the heart and lungs. By correcting the spinal curve through surgery, these serious complications can be prevented.

Spinal Degeneration: Over time, severe scoliosis can lead to degenerative changes in the spine, such as arthritis or disk degeneration, which can cause significant pain and disability. Surgery can help prevent these long-term issues.

When Non-Surgical Treatments Aren’t Effective

Bracing Ineffectiveness: If bracing is not effective in controlling the curve, or if the curve progresses despite bracing, surgery may be the next step. This is particularly true if the curve is worsening rapidly during a child’s growth spurts.

Restoring Balance and Function

Improving Spinal Balance: Surgery can help restore proper alignment and balance to the spine, which is important for overall function and mobility. This can help patients maintain an active lifestyle without the limitations that a severe curve might impose.

What Surgery Involves

Spinal Fusion: The most common surgical procedure for scoliosis is spinal fusion, where the curved vertebrae are fused together into a single, solid bone. This helps to straighten the spine and prevent further curvature.

Instrumentation: Metal rods, screws, and hooks are often used to hold the spine in place while the bones fuse. These instruments provide support and stability to the spine as it heals.

Risks and Considerations

Risks: As with any surgery, there are risks involved, including infection, blood loss, nerve damage, and complications related to anesthesia. However, advances in surgical techniques have made scoliosis surgery safer and more effective over the years.

Recovery: Recovery from spinal fusion surgery can take several months, and physical therapy is often recommended to help regain strength and flexibility. Most patients can return to normal activities, including sports, after they have fully healed.

Long-Term Outcomes

Success Rates: Scoliosis surgery has a high success rate, with most patients experiencing a significant reduction in the spinal curve and improvement in appearance and quality of life.

Activity: After recovery, most patients can resume a normal, active lifestyle, although they may need to avoid certain high-impact activities.

Our Commitment to Research and Improving Patient Outcomes

As part of A/Prof Buckland’s standard of care, he asks patients to participate in the Australian Paediatric Spine Registry in addition to allowing contribution of your de-identified surgical and outcomes data to Harms Study Group and/or Paediatric Spine Study Group to allow surgeons to improve quality and safety of scoliosis surgery care for future patients. A/Prof Buckland will discuss these initiatives with you and your family and obtain your permission before doing so.

In summary, surgery for scoliosis is performed to prevent further progression of a severe curve, improve appearance and posture, alleviate pain, prevent long-term health complications, and restore spinal balance and function. Click here to learn more about A/Prof Buckland’s results of scoliosis correction surgery.