Scoliosis in Children

What is scoliosis?

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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?

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In over 80 percent of cases, the cause of scoliosis is unknown—a condition called idiopathic scoliosis. Scoliosis is more common in females than males.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five out of every 1,000 children develop spinal curves that are considered large enough to require treatment.

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.)

Other causes of scoliosis may include:

• Hereditary conditions that tend to run in families

• Differences in leg lengths

• Injury

• Infection

• Tumors

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.

The following other diagnostic procedures may be performed for nonidiopathic curvatures, atypical curve patterns, or congenital scoliosis:

• Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.

• Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present.

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 degrees 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 degrees 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 degrees 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.

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.