Hemivertebra produce a growth imbalance in the spine and, therefore, result in the spine growing crooked. This is the type of scoliosis i have, its in the lumbar....It sucks but i'm learning to live with it and love it.

Neuromuscular scoliosis

Neuromuscular implies there is some type of problem with the muscles that support the spine. At times, the body does not have the strength to support the spine, and gravity causes the spine to curve. Other times, the body pulls unevenly on different sides of the spine. Children with neuromuscular scoliosis usually have problems with other muscle groups, and may struggle or be unable to walk. The most common cause is cerebral palsy - a syndrome caused by a brain injury within the first two years of life. Children often cannot walk and have developmental delays. Some forms are very mild, while others involve all of the extremities.

Scoliosis occurs in approximately 50% of children with cerebral palsy. Other causes are injuries or syndromes that affect the spinal cord. Spina bifida (a failure of the bony portions of the spine to form properly around the nerves) may cause no abnormalities, or paralysis in the legs. The higher the lesion, the more likely scoliosis will occur. Similarly, gun shot wounds or severe injuries to the spine during growth may cause paralysis and scoliosis.

Degenerative scoliosis

Scoliosis can also develop later in life, as joints in the spine degenerate and create a bend in the back. This condition is sometimes called adult scoliosis. Degenerative scoliosis is a medical condition where a right-left curvature of the spine develops, due to degeneration of the disc. This misalignment of the spine can cause back and/or leg pain, due to muscle fatigue and nerve impingement. Patients suffering from scoliosis often undergo back surgery to restore proper alignment and disc height. During the procedure, the surgeon removes most of the disc between the two or more vertebrae that are to be stabilized and implants a spacer to restore correct spinal alignment. The surgeon also implants bone-forming cells that bridge the space between the vertebrae and allow the bone to grow together. Increased stability and restoration of alignment often result in significant pain relief.

Idiopathic scoliosis

By far the most common form of scoliosis is idiopathic (“idiopathic” refers to a disease or condition of unknown origin) scoliosis, which most often develops in adolescents and typically progresses during the adolescent growth spurt. Because it most often occurs during adolescence, this condition is sometimes called adolescent scoliosis. There is no known cause of idiopathic scoliosis  although it does tend to occur in families. The risk of curvature progression is increased during puberty, when the growth rate of the body is the fastest. Scoliosis with significant curvature of the spine is much more prevalent in girls than in boys, and girls are eight times more likely to need treatment for scoliosis, because they tend to have curves that are much more likely to progress.

This is a 6 year old boy with a hemivertebrae at L4 treated by excision. The associated curvature corrected from 37° to 0. The boy had no restrictions after 6 months.

Congenital scoliosis

Congenital scoliosis is a curvature of the spine that results from anomalies or abnormally developed vertebrae, the building blocks of the spinal column.  These anomalies occur in utero at 4-6 weeks of gestation.  Specific abnormalities include hemivertebra, which is a wedge-shaped or half vertebra, unsegmented bar, which is a failure of the normal separation of the individual building blocks of the spine, and mixed abnormalities.  The number of abnormal vertebra, their location, and the growth potential around these abnormal vertebrae, is what determines how severe congenital curvature will become.  For very mild single vertebra anomalies, a deformity may not be readily apparent and may be picked up incidentally on a chest x-ray or other study done for another purpose.  In patients in whom multiple anomalies are noted, the trunk may be severely shortened and severe spinal deformity may be noted. In these cases, the curvature will often progress, resulting in severe lung disease and/or neurological deficits if left untreated.

Patients with congenital scoliosis also have a high incidence of abnormalities in other organ systems.  For example, there is a 10% incidence of cardiac abnormalities, a 25% incidence of genito-urinary abnormalities, and up to a 40% incidence of intraspinal anomalies.  Therefore, the patients are carefully worked up and even patients, who are seemingly otherwise normal, are sent for testing prior to surgery. Tests performed include an echocardiogram, renal (kidney) ultrasound, and screening MRI of the entire spine.  Intraspinal anomalies that can occur include lipomas or fatty benign tumors of the spinal canal, scar tissue within the spinal canal, bony or cartilaginous spicules within the spinal canal, (diastematomyelia) and various other problems.  These may require separate treatment from the spinal curvature itself.

The treatment for congenital scoliosis is aggressive in that if progression is noted, even for relatively small curves, surgery is indicated.  This turns out to be the most conservative approach in that early surgery often allows the patient to avoid much more extensive surgery later.  It is not uncommon for patients of one to one and a half years of age to undergo surgery that is relatively limited in nature.  Nonoperative treatment consists of observation at 4 to 6-month intervals and if progression is noted, surgery is indicated.  Bracing may be used in only a small percentage of patients in whom compensatory curvatures adjacent to congenital anomalies may be treated to prevent them from worsening.

Thoracolumbosacral orthosis (TLSO) & Milwaukee brace

In children their bones are still growing and they might have moderate scoliosis, the doctor may recommend a brace. Wearing a brace won't cure scoliosis, or reverse the curve, but it usually prevents further progression of the curve. Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.

Braces are discontinued after the bones stop growing. This typically occurs:

1. About two years after girls begin to menstruate
2. When boys need to shave daily


Braces are of two main types:
1. Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured to conform to the body. Also called a thoracolumbosacral orthosis (TLSO), this close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips. Underarm braces are not helpful for curves in the upper spine.

2. Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the head. The brace has a flat bar in the front and two flat bars in the back. Because they are more cumbersome, Milwaukee braces usually are used only in situations where an underarm brace won't help.

i wish they had thought about making the spinecor brace look like this back in 2000, i had to deal with that hard boston brace tlsoa