If your child appears to have poor posture, it may be more than just youthful rebellion at standing up straight. It could actually be scoliosis, which affects 2 to 3 percent of the population or an estimated six to nine million people in the United States.
Scoliosis is a sideways curvature of the spine. Everyone has normal curves in the spine which, observed from behind, looks straight. However, children and teens with scoliosis have an abnormal S-shaped or C-shaped curve of the spine. It can appear on either side of the spine and in different places along the backbone. In most people, the cause of scoliosis is unknown.
The Importance of Scoliosis Screening for Children
Scoliosis most often develops in kids between 10 and 14 years of age and can rapidly progress. Girls tend to be more affected than boys. A recent change in detecting the condition that parents should know about is that school screenings for scoliosis were eliminated last year as a budget issue. So the extra screening that once could have led to a professional evaluation no longer exists. Why is this a concern? Scoliosis screening is a routine part of well-child visits, however most healthy kids only see their pediatrician once a year. Scoliosis can progress rapidly, and not all pediatricians know what the curvature threshold is for a referral for evaluation. Additionally, many kids are body conscious and may shy away from going shirtless, so parents may not have the opportunity to observe an abnormal curvature in their child’s spine.
Scoliosis may be suspected if:
- The shoulders are uneven or one shoulder blade sticks out.
- The ribs on one side are higher than the other.
- One or both hips are unusually high.
- The waist is uneven.
In one study, 23 percent of patients had some back pain at the time of diagnosis.
Early detection of scoliosis is important because, if surgery becomes necessary, treatment while the patient is still in the teens is far more successful and less involved than for patients who have reached adulthood. The recovery period post-surgery is several days in the hospital for younger patients, while for adults, it can be several weeks as an inpatient. Early detection can also:
- Prevent progression of the condition.
- Improve outcomes, by potentially using less invasive treatments.
- Minimize the need for surgery.
- Eliminate long-term complications.
Idiopathic scoliosis—meaning there is no known single cause—is the most common spinal deformity in the world. When there is a spinal abnormality, it is possible there could be another cause besides idiopathic scoliosis. Some children may have a curvature because of a leg length discrepancy. Another condition that can lead to scoliosis is cerebral palsy, and these patients do tend to develop scoliosis in time. There are also some genetic disorders that can lead to scoliosis. In all cases, a physical examination, x-rays and sometimes additional imaging studies are used to diagnose the condition. The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees, with a curvature of 10 degrees or more a definitive diagnosis of scoliosis.
It’s Scoliosis - Now what?
The treatment for scoliosis depends on how soon the condition is diagnosed. Curves of 20 degrees or greater tend to get worse over time. Monitoring milder curvatures may make sense, since your child’s spine is still growing. This includes regular physical exams and x-rays. Treatment also depends on a number of factors including:
- Is the patient’s spine still growing and changing?
- How severe is the curve?
- How high is the possibility of curve progression, especially in adolescents where growth spurts are expected?
The first and most conservative treatment is bracing. This treatment is effective when children are still growing and the curve is between 25 degrees and 40 degrees. While there is debate on which type of brace is most effective, studies show that braces successfully halt curve progression in about 80 percent of children with scoliosis. Braces need to be worn about 18 hours every day until growth stops. It may take a few years of bracing before scoliosis is fully corrected.
Some types of physical therapy can also be beneficial in treating scoliosis. A technique of physical therapy called Schroth exercises work comprehensively on posture, strength, breathing, the functions of daily life and self-image. Chiropractic treatments have not been proven effective in treating scoliosis.
If interventions are too late and the curvature has reached 45 - 50 degrees, then surgery is usually necessary. The goal of spinal surgery is to prevent the curvature from worsening irreversibly into adulthood.
Innovative Scoliosis Treatment
At MemorialCare Miller Children’s & Women’s Hospital, new surgical treatments such as magnetic growing rods are an alternative to spinal fusion. The rods can be lengthened over several of months using an external magnet to accommodate a growing spine, rather than requiring multiple surgeries as a child grows. The ExcelsiusGPS® system uses a robotic arm guided by mapping based on a child’s unique anatomy to accurately conduct spine surgery with precision.
If you would like to find a pediatrician who can evaluate your child for scoliosis, our care team is ready to help. Remember, early detection is the most important step you can take to ensuring your child grows up with a spinal column that will optimize their chances of success as an adult.
Bio
Dr. Torin J. Cunningham is a board-certified orthopedic surgeon and medical director of the Orthopedic Center at MemorialCare Miller Children’s & Women’s Hospital. Dr. Cunningham specializes in spinal deformity/scoliosis surgery for children and adolescents, hip reconstructive surgery and general pediatric orthopedic care. in 2021 and 2022, he was also recognized as a Top Los Angeles Doctor by the Los Angeles Business Journal. in 2021 and 2022, he was also recognized as a Top Los Angeles Doctor by the Los Angeles Business Journal.
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