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 5th-7th
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.
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:
- www.childrenshospital.org
- www.orthoinfo.aaos.org (American Academy of Orthopaedic Surgeons)
- www.srs.org (Scoliosis Research Society
- 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.
- Sevastik JA, Stokes IAF: Idiopathic scoliosis: Terminology. Spine: State of the Art Reviews 2000, 14:299-303.
- Nissinen M, Heliƶvaara M, Ylikoski M, Poussa M: Trunk asymmetry and screening for scoliosis: A longitudinal cohort study of pubertal schoolchildren. Acta Paediatr 1993, 82:77-82.
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