By Dr. Stelma
Scoliosis is a sideways curvature and deformity of the spine. Although it is most commonly an idiopathic condition (meaning there is no underlying diagnosis or cause), it can sometimes be present in patients with genetic syndromes like Marfan syndrome (a disease of the connective tissue) and neurofibromatosis, or cerebral palsy. However, most children who present with scoliosis are otherwise healthy.
Adolescent idiopathic scoliosis affects 3% of children under age 16. Scoliosis affects all racial groups. Family history is important as it can be related to heredity (this most often shows up in young children).
Warning signs of scoliosis
Parents should watch for the following symptoms, especially in children younger than 10:
- Well localized or constant back pain
- Night pain
- Progressively worsening pain
- Feeling weak or clumsy
- Gait abnormality
- Bowel or bladder incontinence
If your child complains of these or exhibits any of these symptoms, report these to his/her pediatrician.
Screening for and diagnosing scoliosis
Pediatricians check for scoliosis during routine exams by observation (looking for asymmetry), a forward bend test, neurological exam (checking reflexes, sensation, ability to walk on heels and toes), and a full exam testing flexibility, checking leg length and other criteria.
A key component of an exam for scoliosis is an instrument called a scoliometer, which measures the angle of the child’s trunk rotation. Anything over five degrees on a scoliometer in the pediatrician’s office calls for an X-ray to determine the actual curvature of the spine. Here are conditions that suggest your child has scoliosis:
- When measured by X-ray, a curve of less than 10 degrees of asymmetry is considered normal; any measurement above that suggests scoliosis.
- Children who are still growing and have curves of the spine that exceed 20 degrees as revealed on an X-ray should be seen by a pediatric orthopedist for remedial treatment.
- Curves exceeding 30 degrees are most common in girls; smaller curves, however, are equally present in both boys and girls.
- Rib prominence on one side is a common sign of scoliosis.
- Children of any age with more severe spinal curvature of 40 degrees or more should be evaluated by a specialist.
At The Pediatric Orthopedic Center, we recommend annual screening during your child’s annual well visit with their pediatrician, starting in middle school during the preteen-to-early teenage years. This is because formation of scoliosis is fueled by bone/body growth. These screenings can stop when children are fully grown; for girls, this is at about age 14 and for boys, age 16. If your child has been diagnosed with idiopathic scoliosis, your pediatric orthopedist might suggest further examination with the help of low-dose X-ray and 2D and 3D imaging technology with EOS Imaging Technology.
Treatment options are based on the severity of the deformity:
Vitamin D – In the early stages, Vitamin D supplements are recommended to support bone strength.
Scoliosis exercises – the Schroth Method and specialized physical therapy can strengthen the back and improve core strength, which have been shown to improve smaller curves. The Schroth exercises are customized to each person’s unique curvature, and take a 3D approach to scoliosis management by addressing muscular symmetry, spinal rotation, and posture awareness.
Bracing – If the curve is over 25 degrees on the X-ray, customized bracing is needed to help prevent the curve from getting worse. The brace is worn at least 18 hours a day and (like the Schroth regimen) address the 3D spinal deformity to untwist the curve. The child is braced until he or she stops growing, since, as noted above, the curvature change is fueled by skeletal growth.
Surgical procedures for scoliosis
Posterior spinal fusion is the gold standard for surgical intervention for curves over 40-50 degrees (depending on location of the curve). Approximately 5% of teenagers with scoliosis undergo surgery to remediate the deformity.
The number of vertebrae that must be fused depends on the stage of the curve. A pediatric orthopedic surgeon will analyze the diagnostic images carefully to guide the surgical decision. Larger and different types of curves may require a fusion of more segments of the spine.
If the curvature is close to the 40-50—degree mark spinal fusion surgery may still be indicated, but for a short section of the spine. A teenager who has undergone this kind of surgery will remain in the hospital for two or three days following the procedure, and is usually able to return to school within a few weeks. No bracing is required, and the complication rate is low <1%.
Scoliosis and student athletes
It is vital that the student avoid certain sports activities while healing—for three months for non-collision sports and for 12 months for collision sports. After a full recovery and upon the pediatric orthopedist’s recommendation, the student may return to his/her sports at the same level as before surgery.
In fact, following successful treatment, students are encouraged to be active and enjoy sports such as soccer, gymnastics, or track & field; in fact, the more physical activity, the better. This recommendation recognizes how being active and fit contributes to bone health and builds both core strength and back strength. At The Pediatric Orthopedic Center, after their scoliosis treatment, we continue to see very active children and teens—even gymnasts who are able to return to competitions and runners who can still participate in marathons. In fact, Usain Bolt, known as the fastest man in the world, was born with scoliosis. Despite this, Bolt has won nine Olympic gold medals.
Support for children with scoliosis
We find it is helpful for kids—especially teens—to talk to other kids who were treated for scoliosis. There are several online support groups, including Curvy Girls – a peer-run in-person network of support groups founded by a teen with scoliosis.
There are Curvy Girls groups across the U.S. and around the world. The Scoliosis Support Network offers resources to children and families, and there are many others across the country. Ask your pediatrician or pediatric orthopedist about these.
Scoliosis can be easy to diagnose if screened for appropriately and as with all conditions in children, early intervention can make a big difference in terms of treatment options and outcomes. Ask your pediatrician about scoliosis screening during annual exams to ensure your child is growing straight and strong.