Scoliosis, or a curvature of the spine, is a condition that affects almost 7 million people in the U.S. While it does occur in adults, it is most commonly seen in children, especially girls, during periods of growth. Although the deformity is complex and 3-dimensional, often times the spine in a person with scoliosis looks like an “S” or a “C” instead of a straight line.
Adolescent scoliosis is the most common spinal deformity affecting pre-teens and teenagers, however it does not always result in significant pain or discomfort. Scoliosis may also occur in younger children and is often referred to as early onset scoliosis (EOS) in children less than five years old. EOS may significantly worsen as the children grow and cause severe spinal deformity and problems with the lungs or other internal organs.
Signs & Symptoms of Scoliosis
- Uneven musculature on one side of the spine
- Uneven hips, shoulders, or legs
- Difference in the chest or breast area
- Slowed nerve action (in some cases)
Causes of Scoliosis
About 65% of scoliosis cases are from unknown causes. Congenital scoliosis (caused by abnormally shaped vertebrae) accounts for about 15% and the rest is speculated to be caused by neuromuscular disease. Some researchers think genetics may play a role in who develops scoliosis, but it is not completely understood at this point.
Scoliosis Treatment Options
At Emory, we typically use non-operative treatments to minimize the worsening of scoliosis before we consider surgical treatments. Surgery is typically reserved for more severe cases of scoliosis. The vast majority of adolescent scoliosis can be managed with non operative measures including careful observation or spinal braces. Our surgeons have access to many local orthotics groups allowing for accurate and effective bracing for scoliosis.
Emory’s Experience in the Treatment of Scoliosis
Emory Healthcare orthopaedic surgeons have tremendous experience in caring for children of all ages with scoliosis. Our physicians are also unique in that they provide care to patients with scoliosis of all ages. When combined with our adult spine center, Emory is the only center in Georgia capable of treating patients from infancy into adulthood.
Emory pediatric orthopaedists Dr. Robert Bruce, Jr. and Dr. Nicholas Fletcher have extensive experience with growing rod and Vertical Expandable Prosthetic Titanium Rib (VEPTR) for the management of severe scoliosis in young patients. These techniques allow for continued growth of the spine in younger children to allow normal development and function. Emory is also one of the few centers in this region offering Mehta casting which is a non-surgical treatment in which the doctor manipulates the spine and then places the child’s torso in a plaster cast. This is especially useful for young children with early onset scoliosis and has been found to actually correct the curvature in certain patients.
Scoliosis Research On the Horizon
Our physicians have been involved in research evaluating opportunities to maximize scoliosis care in children of all ages and assess the long term outcomes of scoliosis surgery. Our research has been presented locally, nationally, and internationally in places as far away as Japan. Dr. Fletcher’s research has focused on clinical outcomes following scoliosis surgery including one of the longest term follow up studies on modern surgical treatment ever published.
Drs. Bruce and Fletcher are currently heading a study highlighting our post operative care following scoliosis surgery which has resulted in discharge 50% faster than the national average without any difference in complications allowing for early return to school for children and work for their parents. Another study is examining discrepancies in access to healthcare and the impact this may have on scoliosis severity.
About Dr. Robert Bruce, Jr.
Dr. Bruce has been a fixture in the Atlanta community for 17 years having started practicing at Emory in 1995. His interests in spinal conditions include caring for all forms of pediatric spinal problems with an emphasis on idiopathic scoliosis and scoliosis in patients with cerebral palsy and other neuromuscular disease.
He is the director of the Children’s Healthcare of Atlanta (CHOA) cerebral palsy program and has a tremendous experience caring for all types of orthopaedic conditions in children with cerebral palsy from the spine to the hips to the feet. Dr. Bruce is also specialty trained in Ilizarov and the treatment of leg length differences and angular deformities. Outside of his clinical duties, Dr. Bruce serves on the CHOA medical board, is the past medical director of Egleston campus, and is currently the head of the orthopaedic team at Egleston hospital.
About Dr. Nick Fletcher
Dr. Fletcher has been practicing at Emory since 2010 and cares for all forms of pediatric spinal problems including adolescent scoliosis, neuromuscular scoliosis, congenital scoliosis, early onset scoliosis, kyphosis, and spondylolisthesis.
He also has spoken locally, nationally, and internationally on his research in scoliosis. His work on adolescent scoliosis has been presented as far away as Japan and he has published multiple studies on early onset and adolescent scoliosis. His current research on comparing spinal casting and growing rod surgery was recently nominated as a top 10 podium presentation at the Pediatric Orthopaedic Society of North America meeting. He also received the 2010 T. Boone Pickens Award for Spinal research for his research in Adolescent Idiopathic Scoliosis.
Dr. Fletcher also specializes in pediatric and young adult hip conditions including hip dysplasia, femoroacetabular impingement (FAI), perthes disease, avascular necrosis, and slipped capital femoral epiphysis. He is one of only a handful of surgeons in the southeast with expertise in the Ganz or periacetabular osteotomy (PAO) for hip dysplasia and the modified Dunn osteotomy for slipped capital femoral epiphysis. He takes care of children of all ages with hip conditions in addition to young adults with hip dysplasia and impingement.