The treatment is determined by the cause of the scoliosis, the size and location of the curve, and the stage of bone growth (how near the growth centers are to closure). Most cases of adolescent idiopathic scoliosis require no treatment (less than 20 degrees) but should be followed at regular intervals (often every 6 months).

As curves progress above 25 to 30 degrees in a child who is still growing, bracing is usually recommended to help slow the progression of the curve. Their are many different kinds of braces used which have names such as the Boston Brace, Wilmington Brace, Milwaukee Brace and Charleston Brace, named for the centers where they were developed.

Each brace a different appearance and there are different ways of using each type properly. The selection of a brace and the manner in which it is used is determined by many factors, including the specific characteristics of your curve, and will be decided on by you and your doctor.

A back brace does not reverse the curve; rather the spine is straightened by the brace from asymmetric pressure, and can be adjusted with growth. Bracing is not effective in congenital or neuromuscular scoliosis and is less effective in infantile and juvenile idiopathic scoliosis.

Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of progressing even after bone growth stops.

Surgical correction involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is performed through an incision in the back and sometime through an incision on the abdomen or beneath the ribs. A brace may be required to stabilize the spine after surgery.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.

Physical therapists and orthotists (orthopedic appliance specialists) can be helpful in explaining the treatments and ensuring a comfortable fit of the brace to increase compliance with the treatment plan.

The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance of progression after growth has stopped.

Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except maybe an increased incidence of low back pain when they get older. People with surgically corrected idiopathic scoliosis also do very well and can lead active, healthy lives.

Patients with neuromuscular scoliosis by definition have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Babies with congenital scoliosis have a wide variety of underlying deformities and management of this disease is difficult and often requires many surgeries.

• emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically bracing)
• spinal cord or nerve damage from surgery or severe, uncorrected curve
• failure of the bone to fuse (very rare in idiopathic scoliosis)
• spine infection after surgery
• low back arthritis and pain as an adult
• respiratory dysfunction from severe curve

Call your child's health care provider if you suspect that he or she may have scoliosis.