Idiopathic Scoliosis: A Surgeon’s Perspective

Patient scans generated by the EOS® machine.

Idiopathic scoliosis is a curvature of the spine that occurs for unknown reasons. Most often it is detected in late childhood or adolescence and is managed based on the severity of the curve and the growth remaining in the child. The curve is measured by degrees of the angle on a standing X-ray. Most curves do not progress and the patient will simply be monitored by a physician throughout his/her childhood and adolescence.

The two traditional treatment methods for a significant curvature are bracing and surgery. Bracing is only utilized if the child has a 25- to 35-degree curve and at least two years of remaining growth (bracing in a person who has finished growth is futile). Surgery is not usually indicated for any curvature that is less than 50 degrees. There are also many holistic and chiropractic methods for treating scoliosis, and while most are not harmful, they have not stood up to scientific rigor in terms of altering patient outcomes. Staying fit is always important for the scoliosis patient (particularly with core strengthening activities such as rowing, yoga or Pilates) but these fitness activities will likely not slow or change the curve progression.

The world of scoliosis detection and treatment is constantly evolving. In the more than twenty years I have been at HJD and NYU Langone, I have witnessed and been involved in the transition from casting and bed rest to minimal bracing and an early return to sports; CAT scans with spinal injections (myelograms) to rapid and accurate MRIs (no radiation); bracing that was bulky and uncomfortable to bracing that is barely noticeable under clothes. We have evolved from guessing if scoliosis in a young person is progressive, to the ScoliScoreTM AIS Prognostic Test, which can accurately predict - with only a saliva test - if the child’s curve will progress; from standing X-rays that exposed the child to repeated radiation, to our new EOS® machine at the Center for Musculoskeletal Care, which has one-tenth the radiation exposure; and from surgery that required postsurgical bracing and corrected the curvature minimally, to surgery that corrects the curve, balances the spine, and allows the patient to return to normal activity in weeks.

At the Center for Children, we continue to work on improving outcomes for our scoliosis patients and easing their care. I look forward to the next twenty years of evolution, when steps in treating the biology of scoliosis will completely change the outlook we have today for patients with this condition.

David S. Feldman, MD