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Scoliosis

Scoliosis Basics

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Updated June 18, 2014

Scoliosis is a sideways curvature of the spine, and although it can occur at almost any age, when most people think of scoliosis, they are usually thinking about adolescent scoliosis or the type that affects teens.

Most cases of scoliosis are idiopathic, or without a known cause, however, scoliosis can also be secondary to connective tissue disorders, neurologic disorders, including cerebral palsy, and musculoskeletal disorders. Scoliosis is not caused by playing sports, having poor posture, or carrying a heavy backpack.

Scoliosis is also classified based on the age of diagnosis. In addition to adolescent scoliosis, children can have juvenile scoliosis, which is diagnosed between the ages of 3 and 10 years, and infantile scoliosis, which is present before age 3.

Scoliosis Symptoms

Kids with uncomplicated scoliosis don't usually have any typical symptoms that you would think of, such as back pain, muscle aches, back spasms, trouble walking, leg pain, or muscle weakness. Instead, their scoliosis is usually detected at a scoliosis screening at school or during a routine physical exam by their Pediatrician or Family Doctor.

Children with scoliosis do typically have physical signs of scoliosis though, which can include:

  • a 'hump' on one side of their back when they bend forward (the forward bending or Adams test)
  • a sideways curve to their spine
  • uneven shoulders
  • uneven hips
Kids with more severe scoliosis and very large curves can begin to have symptoms, including difficulty breathing, chronic back problems, and problems with their self-esteem.

Diagnosis of Scoliosis

The initial diagnosis of scoliosis is usually made by a physical exam using the forward bending or Adams test. Although some doctors then use a scoliometer to measure the curve if the child is thought to have scoliosis, for a more definitive diagnosis, a scoliosis x-ray is usually done. The radiologist can then use the Cobb method to see how much scoliosis your child has or how many degrees her curve is.

In general, scoliosis is defined as a lateral curve of the spine greater than 10 degrees, as measured on a standing x-ray.

Scoliosis Treatments

Fortunately, the majority of teens with scoliosis won't need any treatment at all. Whether or not a child needs treatment for their scoliosis depends on how far into puberty they have progressed (scoliosis tends to worsen as you enter and progress through puberty and get taller, especially the early years of puberty), their Risser grade (which can be detected on an x-ray), and the degree of their curve.

Treatments for scoliosis includes bracing for curves between 25 to 40 degrees and surgery for curves over 40 to 50 degrees. Again, treatment depends on a child's stage of development, so a child with a 30- or 35-degree curve who is close to finishing puberty might not need any treatment at all.

For children with scoliosis who don't require treatment, scoliosis xrays are usually repeated every 6 months or sooner if the doctor is worried that the curve might quickly worsen, until the curve stops increases or the child stops getting taller. A referral to a Pediatric Orthopedic Surgeon can also be helpful to evaluate children with large curves or curves that are rapidly increasing.

Exercises or other alternative treatments have not been proven to help children with scoliosis.

What You Need To Know

  • About 2 to 4% of teens have scoliosis and although it occurs equally in boys and girls, girls are more likely to have larger curves and need treatment for their scoliosis.

  • Scoliosis can run in the family.

  • Scoliosis shouldn't usually limit your child's activity or participation in sports.

  • Only about 10% of teens who are diagnosed with scoliosis go on to need treatment, so even if your child has scoliosis, there is a good chance he won't need any treatment for it, besides an occasional xray to make sure it isn't getting worse.

  • Scoliosis tends to increase the most when a child is at Tanner stage 2 or 3, so the early years of puberty are an important time to keep your visits to your Pediatrician and monitor your child's scoliosis.

  • A brace does not usually 'fix' the child's scoliosis, but instead just keeps it from getting worse.

  • There is some controversy in the medical community about when and how often scoliosis screening should be done, with the American Academy of Pediatrics recommending early and frequent screening every two years beginning at age 10. Other experts are against routine screening or recommend less frequent screening.

Sources:

Behrman: Nelson Textbook of Pediatrics, 17th ed., Copyright © 2004 Saunders, An Imprint of Elsevier.

Adolescent idiopathic scoliosis: review and current concepts. Reamy BV - Am Fam Physician - 1-JUL-2001; 64(1): 111-6.

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