Scoliosis is a common condition that affects many children and adolescents. This condition of side-to-side spinal curves is called “scoliosis”. On an x-ray, the spine of a person with scoliosis looks more like an “S” or a “C” than a straight line. Sometimes parents note that their child’s shoulders or waist appear uneven. Some of these bones may also be rotated slightly, making one shoulder blade appear higher than the other.
Scoliosis is a descriptive term and not a diagnosis. In more than 80% of cases, a specific cause is not known. Scoliosis does not come from carrying heavy things, athletic involvement, sleeping/standing postures, or minor leg length abnormalities. Children with scoliosis and their parents have a lot of questions about the condition. Here, orthopaedic surgeons from the American Academy of Orthopaedic Surgeons and the Scoliosis Research Society answer some of the questions they most commonly hear from patients and their parents.
What is scoliosis?
A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an “S” or “C” and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater.
Scoliosis is a type of spinal deformity and should not be confused with poor posture.
Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis.
What causes scoliosis?
The American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research Society, describe three different types of scoliosis that can occur in children — congenital (present at birth), neuromuscular, or idiopathic:
Congenital. This type of scoliosis occurs during fetal development. It is often caused by one of the following:
- Failure of the vertebrae to form normally
- Absence of vertebrae
- Partially formed vertebrae
- Lack of separation of the vertebrae
Neuromuscular. This type of scoliosis is associated with many neurological conditions, especially in those children who do not walk, such as the following:
- Cerebral palsy
- Spina bifida
- Muscular dystrophy
- Paralytic conditions
- Spinal cord tumors
- Neurofibromatosis (This is a genetic condition that affects the peripheral nerves that causes changes to occur in the skin, called café-au-lait spots.)
Idiopathic. The cause of this type of scoliosis is unknown. There are three types of idiopathic scoliosis:
- Infantile (This type of scoliosis occurs from birth to age 3. The curve of the vertebrae is to the left and it is more commonly seen in boys. Typically, the curve resolves as the child grows.)
- Juvenile (Juvenile scoliosis occurs in children between ages 3 and 10.)
- Adolescent (This type of scoliosis occurs in children between ages 10 and 18. This is the most common type of scoliosis and is more commonly seen in girls.)
What are the symptoms of scoliosis?
The following are the most common symptoms of scoliosis. However, each child may experience symptoms differently. Symptoms may include:
- Difference in shoulder height
- The head is not centered with the rest of the body
- Difference in hip height or position
- Difference in shoulder blade height or position
- When standing straight, difference in the way the arms hang beside the body
- When bending forward, the sides of the back appear different in height
Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. A child experiencing these types of symptoms requires immediate medical evaluation by a physician.
The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your child’s physician for a diagnosis.
How is scoliosis diagnosed?
In addition to a complete medical history and physical examination, X-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the X-ray.
What is the treatment for scoliosis?
Specific treatment of scoliosis will be determined by your child’s physician based on:
- Your child’s age, overall health, and medical history
- The cause of the scoliosis
- The extent of the condition
- Your child’s tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:
- Observation and repeated examinations. Observation and repeated examinations may be necessary to determine if the spine is continuing to curve, and are used when a person has a curve of less than 25 degrees and is still growing. Progression of the curve depends upon the amount of skeletal growth, or the skeletal maturity of the child. Curve progression slows down or stops after the child reaches puberty.
- Bracing. Bracing may be used when the curve measures more than 25° to 30° on an X-ray, but skeletal growth remains. It may also be necessary if a person is growing and has a curve between 20° and 29° that isn’t improving. The type of brace and the amount of time spent in the brace will depend on your child’s condition.
- Surgery. Surgery may be recommended when the curve measures 45° or more on an X-ray and bracing isn’t successful in slowing down the progression of the curve when a person is still growing.
According to the National Institute of Arthritis and Musculoskeletal and Skin Disorders, there is no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, and exercise) prevent the progression of the disease.
How does scoliosis casting work?
A breakthrough technique known as EDF (elongation, derotation, flexion) casting is changing the way that doctors are treating their youngest patients. In this technique, a child is placed under general anesthesia so that the body is completely relaxed. After manipulating the spine into a better position, physicians carefully apply body casts around the patient’s chest and abdomen, adjusting the shape of the casts as patients grow. The Casts are is changed every three to six months, gradually straightening the spine. Scoliosis casting relies on the growth potential of the young spine to correct the abnormal curvature, with the casts guiding the spine into normal alignment. Scoliosis casting results in a complete correction for a significant number of patients, making surgery unnecessary. Even in cases where the results are less dramatic, the cast treatment works well in reducing the complexity of a future surgery and delaying surgery to a time when it is safer to undertake, typically after age 10 for girls and 12 for boys.
Physicians have found that children adapt surprisingly well to scoliosis casting. The treatment allows them to sleep, bathe, run, and even play in their casts, making the experience easier for both children and parents alike.
What are the benefits of the MAGEC Growing Rod?
MAGEC growing rods can correct or control severe curvatures of the spine. A traditional treatment for severe scoliosis includes spinal fusion surgery where lengthening rods are fused to the spine. The rods require surgeries about twice a year to manually lengthen the rods, straightening the curve as a child grows.
MAGEC rods offer an alternative to spine fusion surgery. MAGEC rods are magnetically controlled with the external remote control, allowing our orthopaedic surgeons to lengthen the rod in a non-invasive manner during a child’s course of treatment. Our surgeons lengthen the rod every three to four months during an out-patient clinic appointment using the remote control. The procedure takes just a few minutes!
The MAGEC growing rod treatment benefits include fewer surgeries, faster spine correction, and less pain. Despite the benefits, MAGEC rods aren’t for every patient. Our surgeons will tailor an approach that provides the best possible outcome for your child.
What is the long-term outlook for a child with scoliosis?
The management of scoliosis is individualized for each child depending on his or her age, amount of curvature, and amount of time remaining for skeletal growth. Scoliosis will require frequent examinations by your child’s physician to monitor the curve as your child grows and develops. Early detection is important. If left untreated, scoliosis can cause problems with heart and lung function.