When viewed from the front or back, the spine should remain straight. Scoliosis, however, means that the spine has developed an “S” - shaped curve from side to side. Most people with scoliosis live no differently than anyone else--they can play sports and be physically active. If, however, a curve becomes worse over time, your doctor may decide to treat it.

Symptoms
If you have scoliosis, you might not even notice anything wrong with your back. Most kids who have scoliosis never feel any pain, for example. In addition, the curves in a scoliotic spine often go unnoticed by the patient or other family members. This is why a nurse or gym teacher often screens kids at school by asking them to do the “Adam’s Forward Bend Test.” When a person bends over, any curvature in the spine becomes more visible. Other signs of scoliosis include one shoulder that appears higher than the other or an unevenness in the hips. A "rib hump," a hump on the back that sticks up when the spine is bent forward, may also indicate the presence of scoliosis.
How your doctor decides to treat your scoliosis will depend on your age, how mature your skeletal system is, and how large the curvature is.

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If you have just learned you have scoliosis, you may wonder if your curve will continue to grow bigger. Not even your doctor can answer this question with absolute certainty, but reasonably accurate predictions can be made based on the location and size of the curve(s), your age, and your skeletal maturity. Studies of scoliosis have shown that:

• Curves in the thoracic spine (middle of your back) are more likely to get worse than those in the lumbar spine (your lower back). The likelihood of a curve getting worse is linked to the size of the curve. Larger curves are more likely to grow even bigger. If a curve develops at a young age or before a girl begins her period, it is more likely to get worse.
• The more mature your skeletal system is, the less likely the curve will continue to grow.

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The most common type of scoliosis first appears at around age 10 to 15. About 10 percent of kids this age have some degree of scoliosis. Fortunately, most cases of scoliosis at this age involve small curves that don’t require a doctor’s care. Both boys and girls can get scoliosis; however, scoliosis usually progresses much more rapidly in girls than it does in boys.

The cause of most types of scoliosis is still unknown. Scientists have explored many different theories to explain why some kids get scoliosis while others don't, but we still haven't pinpointed any specific cause and don't yet know how to prevent it.

Since scientists still don't know what causes scoliosis, there is nothing that you can do--or could have done--to prevent scoliosis from happening.

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If you have just learned you have scoliosis, you probably don't feel very lucky. Early detection, however, makes scoliosis much easier to treat. If you are not yet a teenager, your doctor has many options to treat your scoliosis and try to prevent the curve from growing.

Monitoring
If you have a small curve in your spine, your doctor will probably just recommend regular observation. Most small curves can be monitored without X-rays. If a curve begins to get larger, however, it may be necessary to take X-rays every four to six months.

Exercise
Although exercise will not make your curve get better or worse, exercise helps to keep your muscles flexible, and is therefore always beneficial. So after learning you have scoliosis, remain fully active, continuing to participate in any sports and activities without restriction.

Bracing
If you have a medium-sized curve--especially if you are still growing and the curve will most likely get bigger without treatment, your doctor may prescribe a brace for your back. Your doctor will explain to you how to wear it and how much to wear it.

Like many kids with scoliosis, you might feel self-conscious about wearing a brace. Though the brace can help the curve from getting worse, it may take some time for you and your parent(s) or caregiver to get used to it. During the pre-teen and teenage years, appearance is very important to most kids. Despite your self-consciousness, it is important to wear the brace every day for the number of hours decided by your doctor. This will help to keep the curve in your back from getting bigger. Talk to your parent(s) or caregiver about how you feel about the brace and look for ways to help manage these feelings.

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If you have a small spinal curve, it will probably not become much worse once your skeletal system stops growing--and you will therefore not need surgery. So unless you have a large curve or a medium-sized curve that has not responded to brace treatment, your doctor will probably not even consider surgery.

The main surgery for scoliosis is spinal fusion with instrumentation (hardware inserted around the spine to help straighten it). Nearly all spinal fusion surgery uses some type of rods to straighten the spine. While using instrumentation to straighten the spine, the surgeon will also fuse two or more vertebrae together to provide spinal stability. Newer surgical techniques allow for shorter fusion, better correction, and a quicker recovery.
The surgeon may use a posterior approach, which involves going into the spine through the back; an anterior approach, which is performed from the front or side; or a combined approach (actually two operations, one performed from the front and one from the back). The approach that's best for you depends upon the flexibility of your spine, the location and degree of the curve, and whether there is pressure on any of the nerve roots. Your age is also a factor in your doctor's choice of which type of surgery to use. Patients whose spines are immature are more likely to require combined anterior and posterior fusion (see below).

Anterior Instrumentation
After making an incision in the chest or side, the surgeon will remove the intervertebral discs in the area of the curve to make the spine more flexible. The surgeon will then place screws in the vertebrae and connect them with a metal rod. A bone graft is put in place of the removed discs so that the vertebrae sitting next to each other will fuse together. The surgeon will then tighten the screws attached to the metal rod, thereby straightening the curve.

Posterior Instrumentation
After making an incision in the back, the surgeon will attach anchors to the spine in the form of hooks, screws, or wires. These anchors are attached to spinal rods that straighten the spine. As in the anterior approach, bone grafting will be used to fuse all involved vertebrae.

Combined Anterior/Posterior Approach
Combined approaches are usually necessary only for very severe, very stiff curves. This surgery, which consists of two operations--one through the front, and the other through the back--may be staged on separate days or as part of one longer surgery. Since they are performed on two different days, staged procedures require a longer hospital stay than a single surgical procedure.

Other Considerations
The decision about whether or not to undergo any surgery--even when strongly recommended by a doctor--ultimately rests with the patient and, if underage, his or her parents. Any surgery carries some degree of risk. Before you decide against spinal fusion surgery recommended by your doctor, however, consider also the risks associated with leaving large spinal curves untreated:

Increased Back Pain - Patients with untreated large curves can suffer from daily back pain.

Reduced Respiratory Function - Large curves can lead to deformities that decrease the space for the body's vital organs, such as the lungs and heart. The reduction in space can compromise the ability to breathe and the proper functioning of the heart. In curves greater than 100 degrees, these affects can be life threatening.

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