Teens: Correcting the Curved Spine of Scoliosis

by Food and Drug Administration (FDA)

When Laura Bradbard was 12, her mother noticed a lump on her back and was concerned it might be a tumor.

"It was my rib cage rotating," Bradbard says today, 38 and working as a secretary in Rockville, Md. "The lump was my shoulder blade and ribs protruding out the back. X-rays showed my spine was growing sideways, curving in the shape of an 'S.' The doctor said I should do something about it before it got worse."

Sideways curvature of the spine of 11 degrees or more is known as scoliosis. Bradbard's spine was off-center 36 degrees.

Bradbard has scoliosis — in her case, it's called "idiopathic," which means the cause is unknown. Some 80 percent of patients have this variety. Other cases are due to birth defects, spinal cord injuries, and nerve and muscle diseases such as muscular dystrophy.

Who Gets Scoliosis?

Showing up during the growth spurt at ages 10 to 15, scoliosis strikes 2 to 3 percent of adolescents. For unknown reasons, it affects more girls than boys — an inequality of about 3.6 to 1 overall, but 10 to 1 when curves are 30 degrees or more.

Very mild scoliosis curves, under 20 degrees, are nothing to worry about, doctors say. Even 20-degree curves sometimes improve on their own, with only 1 in 5 worsening, and only 3 in 1,000 worsening enough to need treatment.

When curvature gets worse, the spine twists on its center, slowly pulling the rib cage out of normal position. One side of the rib cage becomes higher at the back and sticks out. The ribs inside the curve scrunch together as those outside the curve spread apart. Although most scoliosis curves are "S" shaped like Bradbard's, some resemble a long "C."

"As a curve approaches 60 degrees," says Martin Yahiro, M.D., "the distorted rib cage restricts expansion of the lungs, causing breathing problems." Yahiro is an orthopedist (specialist in bone disorders) at the Food and Drug Administration's Center for Devices and Radiological Health, which regulates scoliosis treatment devices.

Why some scoliosis curves worsen and others don't is unknown. The larger the curve and the younger the patient when it's discovered, the greater the chance it will worsen, Yahiro says.

Curve Watch

Often, the first clue that scoliosis is developing is an uneven skirt hemline or a difference in pant-leg length. Other early warning signs, which might resemble poor posture to an untrained eye, include a hip or shoulder higher than the other, protruding shoulder blade, or tilted head.

After a thorough examination to rule out other problems, the orthopedist diagnoses scoliosis and orders one or more x-rays (see "X-Ray Safety") to determine the type and extent of the curve. (A person with scoliosis may also have other abnormal curvatures, which can be detected by x-ray and treated along with the scoliosis. If the normal rounding of the back is too great, the condition is called "hyperkyphosis." If the normal forward curving in the lower back is too great, the condition is called "hyperlordosis.")

The American Academy of Pediatrics recommends screening for scoliosis during routine doctor visits at ages 10, 12, 14, and 16. The American Academy of Orthopaedic Surgeons and the Scoliosis Research Society recommend screening girls at 10 and 12 and boys once at 13 or 14. Many states have scoliosis screening programs in schools.

Tailored Treatment

Decisions about scoliosis treatment depend on the person's age, gender, general health, and potential for growth, as well as severity and location of the curve.

For a very mild curve, the doctor may only advise monitoring checkups, with x-rays to detect worsening, every three or four months or maybe once a year.

Even moderate curves of 25 to 40 degrees may not warrant treatment, Yahiro says. "If an 18-year-old no longer growing has a 30-degree curve," he says, "I probably would do no more than monitor it. On the other hand, I'd immediately treat such a curve, and often a slighter one, in a 12-year-old just starting the growth spurt."

A severe curve of 40 to 50 degrees or more that's detected early, Yahiro says, would be expected to rapidly get much worse, so he would treat it even more aggressively.

Another important factor is the patient's attitude toward treatment. For instance, Yahiro says, a worsening 35-degree curve that could have been treated with bracing may, in fact, need surgery if the young person refuses to wear a brace.

Bracing for Prevention

A nonsurgical treatment for moderate curves (24 to 40 degrees) is a body brace. (See illustrations.) Not a cure, bracing is intended to check a curve until growth is completed. It can generally straighten a moderate curve. Unfortunately, as happened with Bradbard, some curves return after the brace is no longer worn.

Bradbard wore a full torso brace, formed from a cast modeled from her body. It consisted of a molded leather girdle, straps, and a neck ring to hold support bars in position. Together, these parts held Bradbard in a position that kept her rigid from chin to hips. Bolts and buckles permitted adjustments as she grew.

"I wore it day and night for 23 hours from eighth grade through 10th," she says, "only taking it off for gym and showers. After a time, it was just part of me. I played neighborhood baseball and basketball and rode a bike wearing it."

But Bradbard's inability to bend meant she couldn't look down, and she had to adjust for this. "I couldn't see the stairs when I was walking," she says, "and I had to carry a desk frame from class to class to hold my books up where I could see them. I had several frames that had belonged to an older girl in school who didn't need her brace anymore."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.