As a precautionary measure in 2004, 13-year-old Mara Howard-Williams visited an orthopaedic surgeon. The diagnosis: scoliosis, or curvature of the spine, that required surgery. Reeling from the unexpected news and anxious about the upcoming surgery, Howard-Williams searched for a support group in the Triangle area. Nothing turned up.

Now 18 years old and a senior at Enloe High School, Howard-Williams has formed “Backtalk,” a scoliosis support group for teens, with backing from her surgeon, Dr. Keith Mankin of Raleigh Orthopaedic Clinic, and WakeMed.

An avid dancer, Howard-Williams had no hint that scoliosis would affect her life. But her older sister, now a doctor, noticed that her hips were slightly uneven. Her mother, Dorothy Howard, thought they were erring on the side of caution by seeing a physician. “When the X-ray showed a 56-degree curve, [Dr. Mankin] said she would need surgery. As a parent, it was hard to justify surgery because she had no back pain. But the surgeon explained that as Mara aged, the curvature would continue to grow.” Howard said.

Mankin said a less than 20-degree curve in the spine is mild and does not need to be treated. More than 25 degrees involves a brace while the child still has growth potential. “The type of brace I recommend is a bending brace that they wear only at night,” Mankin said. “The contrast of the look on their faces when I say ‘you need a brace’ and the relief when I say, ‘but you don’t have to wear it to school’ is huge.”

When the curve is over 40 degrees, like Howard-Williams’, surgery is required.

Throughout the process, Howard-Williams wished she had someone to talk to. There was a slight chance the surgery could result in paralysis. It was unknown how active she could be or if she would be able to dance, and the three-month to one-year recovery time seemed daunting.

Scoliosis affects more girls than boys, and many girls also fear surgical scars. Mankin said the most common type of scoliosis surgery is not minimally invasive, although the scar does fall in a “natural cleft in the back” and tends to heal well.

Mankin said the process changes teens. “I’ve seen kids emerge after the surgery stronger; they had been afraid of the world, feeling like victims,” he said. “After surgery, they realize, ‘it wasn’t that bad; I got through it.’”

Howard-Williams, whom her mother describes as “almost Pollyanna-like” in her optimism, came through the surgery and recovery with flying colors.

She has performed in several productions, including “High School Musical” with the North Carolina Theatre.

Almost a year ago, Howard-Williams created the support group with help from Mankin and WakeMed. Members meet once a month at WakeMed’s Health Park at New Bern Avenue. Howard-Williams also meets with patients after surgery to reassure them.

“I do feel like I’m making a difference,” Howard-Williams said. “A couple of members are about to have surgery and have questions about recovery time — how long it will be before they sit, walk, run or ride a bike. And some have questions about bracing that I can’t answer, but other members of the group can. It’s informal; we eat doughnuts and give answers that are honest.”

The next step for Howard-Williams is to create a Web site that will include online chats and forums for people facing scoliosis treatment. After that, she wants to offer scoliosis screenings at schools and dance and gymnastic schools. “If I had been screened in elementary or middle school, I might not have needed surgery,” she said. “Although it did set me back a little, today I can do everything that I could before.”

She is headed to UNC-Chapel Hill in the fall to double-major in chemistry and vocal performance.