Scoliosis is
a sideways curvature of the spine that occurs most often during the growth
spurt just before puberty. While scoliosis can be caused by conditions such as
cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.
Most cases of
scoliosis are mild, but some children develop spine deformities that continue
to get more severe as they grow. Severe scoliosis can be disabling. An
especially severe spinal curve can reduce the amount of space within the chest,
making it difficult for the lungs to function properly.
Children who
have mild scoliosis are monitored closely, usually with X-rays, to see if the
curve is getting worse. In many cases, no treatment is necessary. Some children
will need to wear a brace to stop the curve from worsening. Others may need
surgery to keep the scoliosis from worsening and to straighten severe cases of
scoliosis.
Symptoms
Signs and
symptoms of scoliosis may include:
Uneven
shoulders
One shoulder
blade that appears more prominent than the other
Uneven waist
One hip
higher than the other
If a
scoliosis curve gets worse, the spine will also rotate or twist, in addition to
curving side to side. This causes the ribs on one side of the body to stick out
farther than on the other side. Severe scoliosis can cause back pain and
difficulty breathing.
When to see a
doctor. Go to your doctor if you notice signs or symptoms of scoliosis in your
child. Mild curves, however, can develop without the parent or child knowing it
because they appear gradually and usually don't cause pain. Occasionally,
teachers, friends and sports teammates are the first to notice a child's
scoliosis.
Causes
Doctors don't
know what causes the most common type of scoliosis — although it appears to
involve hereditary factors, because the disorder tends to run in families.
Less
common types of scoliosis may be caused by:
Neuromuscular
conditions, such as cerebral palsy or muscular dystrophy
Birth defects
affecting the development of the bones of the spine
Injuries to
or infections of the spine
Risk factors
Risk factors
for developing the most common type of scoliosis include:
Age
Signs
and symptoms typically begin during the growth spurt that occurs just prior to
puberty. This is usually between the ages of 9 and 15 years.
Sex
Although
both boys and girls develop mild scoliosis at about the same rate, girls have a
much higher risk of the curve worsening and requiring treatment.
Family
history
Scoliosis can run in families, but most children with scoliosis don't
have a family history of the disease.
Complications
While most
people with scoliosis have a mild form of the disorder, scoliosis may sometimes
cause complications, including:
Lung and
heart damage. In severe scoliosis, the rib cage may press against the lungs and
heart, making it more difficult to breathe and harder for the heart to pump.
Back
problems. Adults who had scoliosis as children are more likely to have chronic
back pain than are people in the general population.
Appearance
As scoliosis worsens, it can cause more noticeable changes — including unlevel
shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to
the side. Individuals with scoliosis often become self-conscious about their
appearance.
Preparing for
your appointment
Your child's
doctor may check for scoliosis at routine well-child visits. Many schools also
have screening programs for scoliosis. Physical examinations prior to sports
participation often detect scoliosis. If you are informed that your child might
have scoliosis, see your doctor to confirm the condition.
Tests and
diagnosis
The doctor
will initially take a detailed medical history and may ask questions about
recent growth. During the physical exam, your doctor may have your child stand
and then bend forward from the waist, with arms hanging loosely, to see if one
side of the rib cage is more prominent than the other.
Your doctor
may also perform a neurological exam to check for:
Muscle
weakness
Numbness
Abnormal
reflexes
Imaging
tests
Plain X-rays can confirm the diagnosis of scoliosis and reveal the
severity of the spinal curvature. If a doctor suspects that an underlying
condition — such as a tumor — is causing the scoliosis, he or she may recommend
additional imaging tests, including:
Magnetic
resonance imaging (MRI)
MRI uses radio waves and a strong magnetic field to
produce very detailed images of bones and soft tissues.
Computerized
tomography (CT)
CT scans combine X-rays taken from many different directions
to produce more-detailed images than do plain X-rays.
Bone scan.
Bone scans involve the injection of a radioactive material, which travels to
the parts of your bones that are injured or healing.
Treatments
and drugs
Scoliosis
brace
Scoliosis
surgery
Most children
with scoliosis have mild curves and probably won't need treatment with a brace
or surgery. Children who have mild scoliosis may need checkups every four to
six months to see if there have been changes in the curvature of their spines.
While there
are guidelines for mild, moderate and severe curves, the decision to begin
treatment is always made on an individual basis.
Factors to be considered
include:
Sex
Girls
have a much higher risk of progression than do boys.
Severity of
curve
Larger curves are more likely to worsen with time.
Curve
pattern
Double curves, also known as S-shaped curves, tend to worsen more
often than do C-shaped curves.
Location of
curve
Curves located in the center (thoracic) section of the spine worsen more
often than do curves in the upper or lower sections of the spine.
Maturity
If
a child's bones have stopped growing, the risk of curve progression is low.
That also means that braces have the most effect in children whose bones are
still growing.
Braces
If
your child's bones are still growing and he or she has moderate scoliosis, your
doctor may recommend a brace. Wearing a brace won't cure scoliosis, or reverse
the curve, but it usually prevents further progression of the curve.
Most braces
are worn day and night. A brace's effectiveness increases with the number of
hours a day it's worn. Children who wear braces can usually participate in most
activities and have few restrictions. If necessary, kids can take off the brace
to participate in sports or other physical activities.
Braces are
discontinued after the bones stop growing.
This typically occurs:
About two
years after girls begin to menstruate
When boys
need to shave daily
When there
are no further changes in height
Braces are of
two main types:
Underarm or
low-profile brace
This type of brace is made of modern plastic materials and
is contoured to conform to the body. Also called a thoracolumbosacral orthosis,
this close-fitting brace is almost invisible under the clothes, as it fits under
the arms and around the rib cage, lower back and hips. Underarm braces are not
helpful for curves in the upper spine or neck.
Milwaukee
brace
This full-torso brace has a neck ring with rests for the chin and for
the back of the head. The brace has a flat bar in the front and two flat bars
in the back. Because they are more cumbersome, Milwaukee braces usually are
used only in situations where an underarm brace won't help.
Surgery Severe
scoliosis typically progresses with time, so your doctor might suggest
scoliosis surgery to reduce the severity of the spinal curve and to prevent it
from getting worse. The most common type of scoliosis surgery is called spinal
fusion.
In spinal
fusion, surgeons connect two or more of the bones in the spine (vertebrae)
together, so they can't move independently. Pieces of bone or a bone-like
material are placed between the vertebrae. Metal rods, hooks, screws or wires
typically hold that part of the spine straight and still while the old and new
bone material fuses together.
Surgery is
usually postponed until after a child's bones have stopped growing. If the
scoliosis is progressing rapidly at a young age, surgeons can install a rod
that can adjust in length as the child grows. This growing rod is attached to
the top and bottom sections of the spinal curvature, and is usually lengthened
every six months.
Complications
of spinal surgery may include bleeding, infection, pain or nerve damage.
Rarely, the bone fails to heal and another surgery may be needed.
Lifestyle and
home remedies
Although
physical therapy exercises can't stop scoliosis, general exercise or
participating in sports may have the benefit of improving overall health and
well-being.
Alternative
medicine
Studies
indicate that the following treatments for scoliosis are ineffective:
Chiropractic
manipulation
Electrical
stimulation of muscles
Biofeedback
Coping and
support
Coping with
scoliosis is difficult for a young person in an already complicated stage of
life. Teens are bombarded with physical changes and emotional and social
challenges. With the added diagnosis of scoliosis, anger, insecurity and fear
may occur.
A strong
supportive peer group can have a significant impact on a child's or teen's
acceptance of scoliosis, bracing or surgical treatment. Encourage your child to
talk to his or her friends and ask for their support.
Consider
joining a support group for parents and kids with scoliosis. Support group
members can provide advice, relay real-life experiences and help you connect
with others facing similar challenges.
