Journal of Medicine - At age 12, Mikayla Cunney loves to play tennis and run races. But for 16 hours a day she is restricted by a tightfitting, upper-body brace she must wear to prevent a worsening of the scoliosis that began curving her spine five years ago.

Scoliosis, which affects about seven million Americans, can begin in infancy but most often is diagnosed in people between the ages of 10 and 15, the peak years for growth and development. It can range from a mild curvature that usually doesn't require treatment to extreme deformities that can threaten the lungs and heart. Mikayla, who lives near Sacramento, Calif., has a moderate case of scoliosis, and her doctors hope that a body brace can keep it from progressing to a point where she will need surgery to fuse her spine, which can limit flexibility and range of movement.

Questions remain about the best treatment. While bracing has been used for decades, it doesn't work for everyone; researchers are currently trying to identify when wearing a brace is effective. Meanwhile, new surgical techniques that don't require fusing are being developed to gradually straighten the spine as it grows.

It is also unclear when curvature caused by scoliosis is likely to get worse—girls tend to be at higher risk for this than boys, as are children who begin to develop scoliosis at a very young age. Some doctors are using a new genetic test to determine who is most likely to see the condition worsen.

Schools once regularly tested for the condition, but the practice has fallen off since 2004, when a federal task force said there wasn't enough evidence the screenings were effective. About 18 states still require schools to test children, but scoliosis is most often detected during regular checkups and sports physicals. Parents can also watch for signs, such as one shoulder blade that appears more prominent than the other, uneven hips or a child's body leaning to one side.

When Mikayla was diagnosed with scoliosis at age 7, her spine was curved about 28 degrees from a straight line, considered moderate in older children but worrisome at her age. She started wearing a brace right away, but her father, Andrew Cunney, says doctors' recommendations were mixed on whether she should get surgery. In 2009, a new DNA test known as a ScoliScore, performed at Shriners Hospital for Children in Sacramento, indicated that Mikayla didn't have a high risk of getting significantly worse. Although the test isn't definitive, it helped validate the parents' decision to forego surgery and stick with a brace.

Munish Gupta, an orthopedic surgeon at Shriners who provides brace adjustments and advice on improving her balance and flexibility in sports, acknowledges that bracing's effectiveness is still being studied. But, he says, in 20 years of practice his patients have done well with it, avoiding progression in curvature and invasive spinal-fusion surgery.

Mikayla must wear a brace 16 hours a day to keep her scoliosis from worsening.

Mikayla wears what is known as a Boston brace, which is holding her curve at about 32 degrees. Made of hard plastic and padding, the brace, which can be worn under clothes, often causes hot spots where it rubs. She needs assistance to get into it because it is secured with three straps on the back, which are incrementally tightened for a very snug fit.

"Sometimes she asks, 'Why do I have to wear this stupid thing?' But when we go to Shriners and she sees all the other kids dealing with more severe medical issues, she says she feels lucky," says Mr. Cunney, who works in law enforcement.

A large study currently under way known as Braist aims to compare the risk of progression in adolescents with spinal curves of 20 to 40 degrees who wear braces, versus those who opt for watchful waiting.

"If bracing does work we need to have screening to detect scoliosis early and identify those who need bracing. But if it doesn't work we don't need to encumber these children at the formative stage of life," says lead investigator Stuart Weinstein, a professor of orthopedic surgery and pediatrics at the University of Iowa. The study is being funded by health agencies in the U.S. and Canada. Results are expected in about two years.

Mr. Cunney says if Mikayla's spinal curvature were to worsen beyond 45 degrees, the family would seriously consider surgery. This entails placing metal rods along the spine to straighten it and bone grafts across each vertebra to fuse them together. Unless curves are severe, surgery is usually delayed until children stop growing. But Mikayla is already tall for her age, Mr. Cunney says. He says the family might also consider new surgical procedures that don't involve spinal fusion. While such techniques are new and as yet unproven, they are considered promising for sports-oriented teens to maintain range of movement.

Mia Schloegel, a 12-year-old in Leawood, Kan., swims competitively and is a runner and high-jumper. She was diagnosed last year with a large spinal curve of 47 degrees. Traditional spinal fusion surgery would limit Mia's athletic activities, the family feared. So they went to see Peter Newton, an orthopedic surgeon at Rady Children's Hospital in San Diego who had developed a technique known as tethering to treat the most common form of scoliosis, in which the spine curves to the right.

The technique involves attaching a polyethylene cord with screws to the right side of the vertebrae, restraining the spine's growth on that side. As the left side continues to grow, the idea is that the spine rotates back into correct alignment. Tethers are removed once the child stops growing. Only about 20 such surgeries have so far been performed, Dr. Newton says.

Mia had the operation in February. She took the procedure in stride, though she says she felt like a mummy when, after the surgery, a brace-like cast was molded to her body to protect the spine for a few months.

She did have some pain but was flying a kite on the beach 11 days later. She has some restrictions for now on twisting and turning and lifting objects. By late April, Mia was able to get back in the swimming pool and, she says, "I'm going to be swimming five days a week this summer."

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