Damon DelBello, M.D., a pediatric orthopedic surgeon at Maria Fareri Children’s Hospital specializing in pediatric orthopedics, spoke with us to help us understand scoliosis in children, including its long term dangers, possible causes, and treatment options.
What, exactly, is scoliosis?
Scoliosis is an abnormal bend, usually sideto- side, to the spine that generally occurs in youngsters ages ten and up. When severe, it can cause or interfere with heart and lung function. As an adult, if it gets very severe, it can actually shorten one’s lifespan. In addition, it’s cosmetically deforming and can become painful.
How can a parent tell if their child has scoliosis?
Sometimes it can be visually obvious, depending on where the bend occurs in the spine. Occasionally, a child’s shoulder, waist or hips may become very asymmetric at an early age. Other times the condition can be hidden in the lumbar (lower back) or thoracic (mid-back) spine and not noticed until very late by a parent or doctor.
Because it can be hard to see at first, it is important for your child’s pediatrician, as well as the nurses at school, to do some screening for scoliosis and try to identify it early. A good physical exam is very reliable in at least identifying the presence of a curve. Most likely your pediatrician is well versed in doing a scoliosis exam and can diagnose the condition rather easily.
Right now, we have a genetic test that helps us identify the group of children whose scoliosis is going to progress rapidly, but we do not have genetic testing to determine who is going to get it in the first place.
What causes the condition?
We don’t know. Experimentally we have found abnormalities in the system of the brain controlling the body’s position and balance – your position in space – in people who have scoliosis. Mechanically speaking, we aren’t sure how those abnormalities translate into scoliosis. There are genetic influences, but they are very complicated. There have been upwards of 50 genes associated with scoliosis, and the genetic research is still a work in progress.
What are the options for treatment?
If curves below 30 or 40 degrees that are progressing are caught early there is the option of bracing. Mind you, most curves do not progress and the majority of kids with scoliosis never progress enough to need treatment. But for children whose condition does progress, we can stop that progression with a brace if we catch it early enough.
There are a variety of bracing options. Daytime bracing is very effective. There are also newer night braces. These braces are roughly 80-85% effective in stopping the curve from progressing.
The Rigo brace is a new method that works by de-rotating the twisted spine rather than pushing.
The goal of treatment is to keep the curve below 30 or 40 degrees by the time the patient reaches adulthood. Those curves have a low chance of continued progression through the adult years and are curves that one can endure with minimal symptoms throughout life.
At what point does surgery become necessary?
When we can comfortably say that the curve is very likely to progress as an adult. If the curve is 50 degrees or more it is going to progress and cause complications.
There are different medical procedures available that can be very helpful depending on the age of the child and the remaining time there is for the spine to grow. This includes spinal stapling, a newer method of non-fusion surgery.
We are also performing exciting new procedures that correct the condition with far less surgical intervention. One such procedure is the insertion of a “Magec” rod that lengthens the child’s spine over time using and external magnetic motor. This is a great advance as it eliminates multiple surgeries and less surgeries equate to less pain and recovery time.
What’s one thing a parent can do to protect their children from developing scoliosis?
The most important thing is to make sure a medical professional looks at your child’s spine. Don’t be shy. Ask the question, “Does my child have scoliosis?” It never hurts to check.
Damon DelBello, M.D., is a pediatric orthopedic surgeon at Maria Fareri Children’s Hospital, the children’s hospital for the Hudson Valley and Fairfield County, and a member of the Westchester Medical Center Health Network. 877-WMC-DOCS (877-962-3627). westchestermedicalcenter.com/mfch. David Neilsen is a frequent contributor to Westchester Family.
