Scoliosis is a musculoskeletal disorder that causes an abnormal curve of the spine or backbone. The medical condition is indicated by the curvature of the spine from side to side, sometimes resembling an “S” or a “C,” rather than a straight line.
There are different types of scoliosis, including:
- Adolescent idiopathic scoliosis – the most common type. The cause is unknown. Generally, the condition occurs in children after the age of 10. Girls have a greater likelihood of developing idiopathic scoliosis.
- Juvenile idiopathic scoliosis – affects children between the ages of 3 and 10.
- Infantile idiopathic scoliosis – occurs in children under age 3.
Symptoms of scoliosis
Scoliosis can be hereditary; it is recommended that a child who has a parent or sibling diagnosed with idiopathic scoliosis receive regular checkups for early detection.
Children and teens with scoliosis rarely exhibit symptoms, and sometimes the condition is not obvious until the curvature of the spine becomes severe. Sometimes you may notice that your child’s clothes are not fitting correctly or that hems are not hanging evenly. In some cases, your child’s spine may appear crooked, or his or her ribs may protrude. Look for the following signs, which could be indicators for scoliosis:
- One shoulder appears higher than the other shoulder.
- One shoulder blade sticks out further than the other.
- One hip appears higher or sticks out more than the other.
- The child’s head is not properly centered over his or her body.
- When bending from the waist, the ribs on one side are higher than the other.
- The waistline appears flat on one side.
An app for early detection
As there is often no known cause for scoliosis, early detection is the best way to prevent curve progression. To help with this, the orthopaedic specialists at Shriners Hospitals for Children developed the SpineScreen app, which is available on iTunes and Google Play.
With the SpineScreen app, you can perform a preliminary spine check by simply moving your phone along your child’s back. The app detects abnormal curves, giving parents a quick way to routinely monitor their child’s spine health. As this is strictly an initial check, it should be followed up by a physician’s examination to determine if your child has scoliosis.
“Because there is often no known cause, routine monitoring for scoliosis is an important part of a child’s ongoing health care,” said Amer Samdani, M.D., chief of surgery for Shriners Hospitals for Children — Philadelphia. “It’s a progressive condition, so early diagnosis is key. At Shriners Hospitals, our care ranges from routine monitoring to some of the most advanced treatments for scoliosis. The earlier we see a child, the more options we have available.”
Scoliosis treatment options
Some children with mild spinal curves may require no treatment. For those who do need treatment, your primary pediatrician may refer you to an orthopaedic spine specialist, who will recommend the best plan of treatment based on your child’s age, stage of growth, the degree and pattern of the curve, and the type of scoliosis.
Shriners Hospitals for Children offers a wide range of treatments for scoliosis, tailored to the needs of each individual patient, including:
Observation: For children with an idiopathic curve that measures less than 20 degrees, physicians may follow patients through observation and examine them every four to six months while they’re growing. At this point, no treatment is needed other than the follow-up examinations.
Bracing: Most physicians recommend their patients be fitted for a brace to prevent a curve from worsening when the patient meets the following criteria:
- The child has a curve between 20 and 40 degrees, or has a smaller curve that has gotten worse.
- The child has significant growing left to do. This can be determined through X-rays of the spine, and sometimes of the hand. Also, it is important to note that most girls grow significantly right before and after their first menstrual cycle.
As the child nears the end of their growing period, the specific indicators for bracing will depend upon how the curve affects their physical appearance, whether the curve is getting worse and the size of the curve.
Casting: There are various forms of serial casting that are a possible treatment for some patients with infantile scoliosis and a progressing curve. The casting straightens the spine through the continuous application of force. Casting can be an alternative to bracing, especially when there are compliance issues. Patients must undergo anesthesia when cast changes are required, generally every two to three months.
Scoliosis-specific exercise (Schroth-based programs): For patients with adolescent idiopathic scoliosis, the exercise program is a conservative treatment option designed to maintain or minimize curve progression and improve posture and appearance. Patients participate in several sessions and then continue the program on their own. Patients may still need to wear a brace.
Surgical options: There are several surgical options, including fusion and fusionless techniques. Fusionless techniques include:
- The surgical insertion of “growing systems” which expand as your child grows. These can include growing rods and the vertical expandable prosthetic titanium rib (VEPTR), which require surgery every six months to lengthen the spine.
- Much more commonly today, these patients can be treated with MAGnetic (MAGEC) rods. MAGEC rods are for younger children (generally under the age of 10 with curves greater than 50 degrees. The rods are surgically implanted, but the lengthening procedure is done externally, using a remote-control device.
- Anterior vertebral body tethering (VBT) uses a strong, flexible cord to gently pull on the outside of a scoliosis curve to straighten the spine. See article below to learn more, including about the FDA approval of The Tether™.
- Spinal fusion surgery is used in children with a spinal curve greater than 50 degrees who do not have much growth remaining. Rods and screws are attached to the curved part of the backbone, and the spine is straightened. A bone graft is placed over the spine; it will grow and fuse the spine into a proper position.
Treatment for scoliosis is available at the Shriners Hospitals for Children locations that treat orthopaedic conditions.
TO LEARN MORE about VBT and other treatments for scoliosis, please visit shrinershospitalsforchildren.org.