Pediatric Scoliosis

From the Greek word "skolios," scoliosis means bent. Normally, the spine is a straight line when viewed from the rear, from the neck to the tailbone, but curves slightly outward in the upper back and inward in the lower back. If the patient has scoliosis, though, the spine looks S or C-shaped.

If a child is born with a curvature of the spine, it is called congenital scoliosis. This occurs very early in the mother's pregnancy. If scoliosis is diagnosed when the child is younger than three years old, it is called infantile scoliosis. Between four and 10 years old, it is called juvenile scoliosis. Between ages 11 to 18 years old, it is adolescent scoliosis, which is by far the most common.

Neuromuscular scoliosis refers to the nerves and muscles supporting the spine. It affects children with conditions such as spina bifida, cerebral palsy and muscular dystrophy.

A curvature of 10 percent or more gives the child a diagnosis of pediatric scoliosis. Most children with scoliosis have slight curvatures, defined by small percentages, and do not need treatment. Three to five out of every 1,000 children have curves that are 50 percent or more. These cases almost always require treatment.

How and when is pediatric scoliosis diagnosed?

Excluding congenital scoliosis which is diagnosed at or even before birth, pediatric scoliosis symptoms usually begin when the child has a growth spurt just before puberty. This accelerated growth period typically occurs between the ages of 10 to 14; thus, regular screenings are especially important during this time of life. Until 1998, students were tested for scoliosis in school. Since most states discontinued the mandate that required testing, scoliosis testing is not typically done in schools. 

Today, primary care doctors and pediatricians typically test patients for scoliosis during a school or sports physical by performing the Adams Forward Bend Test. Recommended by the physicians at Midwest Orthopaedics at Rush, this test, which can be done at home, shows the parent how to determine if the child's curvature is more than 10 percent, which calls for a consultation with an orthopedic spine surgeon who specializes in pediatric scoliosis.

To confirm pediatric scoliosis, the physicians at Midwest Orthopaedics at Rush use X-rays, magnetic resonance imaging (MRIs), computerized tomography (CT) scans or bone scans. If the curvature is more than 10 percent, and the child is under 13 years old, the spinal deformity physicians at Midwest Orthopaedics at Rush use a simple, non-invasive test called the ScoliScore to determine the likelihood of progression of the child's scoliosis, based on the child's DNA and genetic markers. When the child is nine to 13 years old, the physician sends a sample of the child's saliva to a laboratory. If the test reveals that the child has "progressive genes," the child's scoliosis will likely progress with time. If the child has "protective genes," it will not progress.

Who is likely to have pediatric scoliosis?

Scoliosis is idiopathic, which means its cause is unknown. It runs in families, but not every parent with scoliosis has children with the condition. It is not an equal-opportunity condition; girls are more likely than boys to have scoliosis that is serious enough to require treatment. The larger the curve, the more likely it will progress. S-shaped curves and curves in the middle of the back progress more often.

In a study conducted by the National Institutes of Health, female ballet dancers were more likely to have scoliosis if they had delayed menarche (first periods) or amenorrhea (absence of menstruation). These conditions go hand-in-hand with the dancers' higher-than-normal incidence of anorexia.

In rare cases, scoliosis is caused by an injury to the spine, a birth defect that affected the growth of the spine or neurological condition such as cerebral palsy or muscular dystrophy.

What is the treatment for pediatric scoliosis?

Non-surgical Treatment

The typical scoliosis diagnosis is mild scoliosis, which requires no treatment. The child sees the physicians at Midwest Orthopaedics at Rush every six months for check-ups. The physicians watch for progression of the condition.

Moderate scoliosis can be treated with a brace, which is fitted while the child is young and the child's bones are still growing. A brace does not correct scoliosis but can prevent it from progressing.

The child wears the brace at all times, but may have the doctor's permission to remove it to participate in sports or other activities. Children with moderate scoliosis wear braces until their bones have stopped growing. For girls, this is about two years after the onset of menstruation. For boys, it is when they have reached their full height.

The physicians at Midwest Orthopaedics at Rush prescribe different types of braces for different degrees of scoliosis. The braces are plastic and molded to conform to the body. As the child grows, new braces must be made.

Surgical Treatment

Severe scoliosis often calls for spinal fusion or lumbar fusion surgery. The spine surgeons at Midwest Orthopaedics at Rush remove a joint from the spine and fill the gap with a bone graft. This makes the spine grow straight.

Surgery complications can include infection, pain or nerve damage. Sometimes additional surgery is required. Through surgery, the physician safely corrects the curve while maintaining balance of the spine. An average amount of correction is usually 50 to 80 percent of the curve.

The pediatric spine surgeons at Midwest Orthopaedics at Rush offer minimally invasive spine surgery (MIS), while many other doctors still use the more invasive method. The traditional technique requires a five- to six-inch incision, but the minimally invasive technique requires a one- to two-inch incision. The result is less blood loss, a shorter recovery time and a lower risk of infection.

After surgery, the patient usually stays in the hospital for a few days. The child must refrain from lifting or strenuous activities for six to nine months and from participating in sports that require upper body movement for six months to a year.

What if the scoliosis goes untreated?

Children with severe scoliosis who are not treated can develop heart and lung damage because the curvature of the spine moves the rib cage and causes it to interfere with these organs. If the spine curves enough, the child may have difficulty breathing. As adults, untreated pediatric scoliosis patients are more likely to suffer chronic back pain.

In addition to the physical complications, untreated scoliosis alters the patient's appearance. The shoulders and hips are uneven and the ribs protrude. The patient becomes self-conscious and may suffer psychological problems.