"Adolescent Idiopathic Scoliosis"- Issue 16

Scoliosis is a sideways curve of the spine. There are several different types of scoliosis that affect children. The most common type is called “idiopathic”, which means the exact cause of the curvature is not known. Idiopathic scoliosis can occur in young children, but mainly occurs from age 10 until the child reaches skeletal maturity.

According to recent research, about 30% of adolescents affected by idiopathic scoliosis have a family history of scoliosis. Because scoliosis tends to be genetic, children with parents or siblings with scoliosis should be checked at their yearly exams and during growth spurts. Girls and boys are equally affected by small degrees of scoliosis. However, girls are eight times more likely than boys to develop progressive curves. Adolescent scoliosis is not life threatening, and most curves do not cause serious problems.  However, if a curve is large enough, it can impact growth, physical appearance, and in rare cases can affect the heart, lungs and nerves.

 Early detection is important, and parents can help identify symptoms. If you can see that one shoulder appears higher than the other, or one side of the ribcage is sticking out more than the other side, it should prompt a call to your pediatrician. Schools will often conduct scoliosis screenings for students in the 5^th-7^th grade. Your child may receive a referral for scoliosis based on the results of this screening.  Scoliosis can then be confirmed with an x-ray of the spine. Your doctor will measure the degree of the curve and then determine the best course of treatment.

The type of treatment will depend on the type and degree of your child’s curve, your child’s age and how much time remains before your child will stop growing. Your doctor will then determine how likely it is that the curve will get worse and then suggest treatment options to meet your child’s specific needs.

         Fortunately, most people with scoliosis do not require treatment other than observation.  For children with mild curves (<25 degrees), or who have already finished growing, your doctor will monitor the curve every 6-12 months to make sure it is not getting worse.

         Curves that measure >25 degrees are typically considered large enough to require treatment. The only treatments shown to directly affect idiopathic scoliosis are bracing and surgery.  There is no current evidence that physical therapy, chiropractic care, acupuncture or exercise can change or slow the progress of the curve.  Research does demonstrate faster recovery and less pain when physical therapy is performed after scoliosis surgery.

         Bracing is considered for moderate curves (25-45 degrees), and for those individuals that have a lot of growing left to do.  The brace will help to prevent a curve from getting worse.     

         Surgical correction is often considered for severe curves (>50 degrees). The operation for scoliosis is a spinal fusion.  This helps to realign and fuse the spine in order to help significantly straighten the spine, stop the curve from progressing, and prevent risk of injury to the heart, lungs and nerves. Although the surgery may not fully straighten the spine, most patients recover from surgery with curves less than 25 degrees.  Most patients can return to non-contact sports within 6 months following surgery and to full contact activities within 12 months after surgery.

Treatment Options:

Mild curves (<25 degrees):

·       For children with mild curves, or who are already fully grown, the doctor will monitor the curve by re-checking with x-rays and examination every 6-12 months

Moderate curves (25-45 degrees):

·       Bracing treatment is used to prevent a curve from getting worse when:

·       A curve is moderate in size

·       A curve is progressing as a child grows (increases by more than 5 degrees)

·       A child has a lot of growth remaining

Severe Curves (>50 degrees):

·       Curves between 40-50 degrees in a growing child fall into a grey area.  Several factors may influence if surgery is necessary

·       Surgery is typically recommended if your curve is greater than 50 degrees in order to lessen the curve and prevent it from worsening

References:

1. www.childrenshospital.org
2. www.orthoinfo.aaos.org (American Academy of Orthopaedic Surgeons)
3. www.srs.org (Scoliosis Research Society
4.  Robinson CM, McMaster MJ: Juvenile idiopathic scoliosis: Curve patterns and prognosis in one hundred and nine patients.J Bone Joint Surg Am 1996, 78A:1140-1148. 
5. Sevastik JA, Stokes IAF: Idiopathic scoliosis: Terminology. Spine: State of the Art Reviews 2000, 14:299-303. 
6. Nissinen M, Heliövaara M, Ylikoski M, Poussa M: Trunk asymmetry and screening for scoliosis: A longitudinal cohort study of pubertal schoolchildren. Acta Paediatr 1993, 82:77-82.