By Cynthia Weiss-Mayo Clinic News Network

Scoliosis is the left-to-right curvature of the spine, which occurs in approximately 1 in 300 children.

Dear Mayo Clinic: My granddaughter was diagnosed with severe scoliosis. What is scoliosis and what are the treatments?

Answer: Scoliosis is the left-to-right curvature of the spine, which occurs in approximately 1 in every 300 children. In growing children, the curve can develop rapidly, especially during adolescent growth spurts.

The compressed growth plate grows more slowly, leading to the gradual wedging of the vertebrae and the progression of scoliosis. The big curve will continue to progress slowly in adulthood, eventually leading to quality of life and even breathing problems.

Usually, a brace can be prescribed to treat mild or moderate curvature by keeping the spine in the correct position as the spine grows. Support can prevent the curve from getting worse, but it usually does not straighten a curved spine.

For some children, the curvature of their spine is obvious, so the diagnosis is severe scoliosis. Severe curvature can be treated with spinal fusion. This reliable and successful procedure that has existed since the 1960s prevents the curve from returning.

With spinal fusion, an 8 to 12 inch incision is made in the back to remove the muscles to reach the spine. Screws and rods are connected to the curved area of ​​the spine, pulling the spine to the correct position. Then remove the small joints at the back of the spine and rough the bones with high-speed burrs.

This process creates a strong bone or fusion at the back of the spine. Depending on the position of the curvature, 6 to 13 of the 17 vertebrae in the back are fused to treat scoliosis, using 14 to 24 screws and two solid metal rods.

However, after the fusion, the spine no longer grows over the area where the spine is fused, and the spine does not move over the fusion area. In most cases, the unfused area of ​​the spine can be compensated, the child is functioning normally, and the spinal movement is acceptable. After fusion surgery, children need to be hospitalized for three to four days and may miss school for about three weeks. Most children can resume normal physical activities and perform most sports within 12 weeks after surgery.

In rare cases, the patient needs a second operation. According to research, only about 2% of patients require a second operation within two years after the first operation.

Once fusion surgery has been performed, there is no reason to perform non-fusion surgery. However, newer procedures that do not involve fusion can be used to treat scoliosis.

The goal of these non-fusion surgeries is to correct scoliosis, but still allow the spine to grow and move. However, the long-term results of these procedures are unclear.

So far, the risk of needing a second surgery after non-fusion surgery is higher-there is a 10%-20% chance within two years after surgery. Two devices approved by the U.S. Food and Drug Administration (FDA) for non-fusion spinal surgery to treat scoliosis-both have passed special humanitarian approval.

The first device is used for vertebral body restraint. Enter the spine through a 1-inch incision on the side and use a special camera during the operation. Metal screws are placed in the curved vertebrae of the spine, and plastic cords connect these screws. The rope is tightened to shorten the long side of the spine side bending line and act as an internal support.

As some children continue to grow, the curve will continue to be revised over time. The rope is flexible, so the spine can still move.

The problems of this operation include safe execution of the operation and prediction of the technical difficulty of scoliosis correction during the operation. Younger patients may need a second surgery to remove the spinal cord after the spine is completely corrected. Other times, the umbilical cord cannot adequately correct the curve and fusion surgery may be required.

The second approved device is used to perform rear dynamic traction. Make a 6 to 8 inch incision on the back. Move the muscles on one side of the spine away. Three screws are placed and connected to a rod with two ball bearing joints to allow movement.

Patients usually stay in the hospital for one night, and then can resume exercise within 8 to 12 weeks. 10%-20% of patients require a second surgery because the screws may loosen, the device may break, and the lateral curvature of the spine may progress or worsen.

— Dr. A. Noelle Larson, Orthopaedics Department, Mayo Clinic, Rochester, Minnesota

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