Some facts parents should know when their child is diagnosed with scoliosis

Scoliosis is more than uneven posture

In scoliosis, the spine curves sideways and the vertebrae may rotate around their axis. Visible signs include uneven shoulders, waist asymmetry or rib prominence on bending forwards. Adolescent idiopathic scoliosis, the most common type in teenagers, is not caused by “sitting incorrectly” or carrying a backpack.^[1]

The diagnosis is clarified by examination and standing front and side X-rays of the entire spine. These measure the Cobb angle and assess curve shape and trunk position. An image of one region alone or a photograph of the back does not show the whole picture.^[2]

Why growth and previous images matter

The same curve size may require different management in a child who is growing actively and an adolescent who has finished growing. Skeletal maturity, curve type and changes over time matter. Dated X-rays are compared to assess progression.^[2]

If observation is chosen, agree the date of the next review and arrangements for follow-up images. Finishing growth may slow progression, but it is not automatically a reason to stop monitoring permanently.^[7]

Bracing and specific exercises: different aims

During growth, a brace helps limit curve progression. In the BrAIST study, it reduced the risk of progression to the surgical threshold in selected adolescents at increased risk. This does not mean guaranteed complete straightening. Results depend in part on brace fit and actual wearing time; the regimen is prescribed individually.^[3]

Scoliosis-specific exercises, including Schroth, may complement the plan. In a small randomised study, adding Schroth to standard care improved the Cobb angle over six months. This does not prove that exercises replace a necessary brace or operation.^[4]

More about non-surgical scoliosis treatment

When to discuss surgery and preservation of mobility

Surgical correction is discussed for substantial deformity, progression or insufficient control with non-surgical methods. The decision considers growth, curve flexibility, trunk balance and expected benefit. One angle on an image does not replace this planning.^[6]

VBT in growing children

A flexible tether attached to the vertebrae provides initial correction and uses further growth to change the curve. Remaining growth is therefore a key selection criterion. Overcorrection, tether breakage and further surgery are possible.^[5]

Dynamic ASC correction

ASC focuses on correcting the deformity during surgery without planned vertebral fusion. In my practice, I consider it for carefully selected adolescents and adults. The possibility of preserving mobility is assessed separately according to flexibility and spinal condition; indications for VBT during growth do not automatically apply to ASC after growth has finished. Long-term data for these patients are limited.

Correction with fusion

Screws and rods hold the corrected position while the selected vertebrae fuse. Movement in that area is restricted. This approach remains an important option when it better addresses the correction goals.^[6]

VBT and ASC: who may be suitable for dynamic correction? · Surgical treatment options for scoliosis

School, sport and supporting your child

Scoliosis itself does not mean an active life is prohibited. Movement is usually beneficial; the sport and level of exertion are clarified according to symptoms and the treatment plan. A separate return-to-activity plan applies after surgery.^[7]

Discuss treatment together with your child. Ask what concerns them: appearance, the brace, lessons or friendships. A practical plan is easier to follow when a teenager understands its purpose and can ask questions.

What to send the professor for preliminary assessment

• Existing standing X-rays of the entire spine in front and side views, the report and previous dated X-rays.
• Your child's age and information about growth: how their height has changed recently.
• Treatment history: which brace was used, wearing schedule, exercises and previous recommendations.
• Symptoms and your questions: pain, changes in appearance, everyday difficulties and any proposed operation.
• MRI/CT scans and discharge summaries, if already available. Send complete cross-sectional imaging studies in DICOM format.

For initial contact, send the materials you already have. Not every child with scoliosis needs a new MRI; further investigations are requested for specific indications.^[2]

How to prepare and send investigations in DICOM format

What to ask at the consultation

• What type of scoliosis is it, and has the curve really increased?
• How much growth remains, and how does this affect treatment?
• What do we expect bracing and exercises to achieve, and when will the result be checked?
• If surgery is needed, why have this method and these levels been selected?
• What mobility do we plan to preserve, what are the risks and could further surgery be needed?
• How should the return to school and sport be organised?

Severe pain, weakness or other neurological changes require separate assessment; they should not automatically be attributed to ordinary adolescent scoliosis.^[2]