Some parents are shocked to hear that their child (usually an adolescent girl) has scoliosis. They ask, “Why didn’t we notice it? Was there something we could have done to stop it?” They feel helpless and guilty.
Three Types
What is scoliosis? Scoliosis is a three-dimensional deformity of the spine. Instead of being a neat stack of vertebrae, the vertebral column twists and rotates to form a “c” or “s” shape to the spine.
There are three types of scoliosis: idiopathic, congenital and neuromuscular.
• Idiopathic scoliosis means the cause is unknown.
• Congenital scoliosis occurs as a malformation of the spinal column prenatally (i.e. a spinal #vertebra forms into a triangle instead of the usual rectangular shape).
• Neuromuscular scoliosis results from a muscular imbalance from a condition affecting the brain
such as cerebral palsy or muscular dystrophy.
Out of Nowhere
Of all the different types of scoliosis, adolescent idiopathic scoliosis (AIS) is the one that seems to appear out of nowhere and potentially, but infrequently, may require surgical treatment. This form of scoliosis usually manifests at the onset of puberty.
Preadolescence is a time when pre-teens and teens become body-conscious and private about their maturing bodies. Typically, a parent first notices something different about their growing child’s body when they are shopping together for clothes or when they see their child in a bathing suit. Physical signs of AIS include an uneven appearance of the shoulders, waistline, hips or rib cage. For girls, it can appear as if one breast is larger than the other.
Idiopathic scoliosis is not caused by bad posture or from carrying a backpack on one shoulder. Idiopathic scoliosis usually does not cause pain and should not interfere with normal daily activities including competitive sports.
Diagnosis and Treatment
If a child is noted to have physical signs associated with scoliosis by a parent or pediatrician, or by a practitioner during “school screening,” he or she will be referred to a pediatric orthopedic surgeon for diagnosis and treatment. Pediatric orthopedists are specialists who evaluate and treat scoliosis in children and adolescents.
An X-ray is necessary to diagnose scoliosis. A spinal curvature of greater than 10 degrees on a proper X-ray is scoliosis. A growing child with scoliosis needs to be followed closely by his or her pediatric orthopedist at regular intervals (usually every four to six months) to assess any increase in the curvature. During the rapid growth period during adolescence, a scoliotic curve may increase at a very rapid rate.
Brace treatment is an option for a patient with growth remaining and progression of the curve magnitude. Generally, patients with curves between 25 and 40 degrees will be treated with a brace. No other treatment has been found to be effective to halt curve progression, but bracing does not work for everyone. Presently, the effectiveness of brace-wear for scoliosis is under investigation by major medical centers throughout the U.S. Most believe that for the brace to be effective it needs to be worn at least 18 hours a day. There are some spinal curves, however, that can be treated successfully with a nighttime brace. Even with proper brace compliance, a child’s curve may still progress.
Beyond the Brace
When the child stops growing (for girls, usually 1 1/2 to 2 years after their first menstrual period; for boys, when they start shaving), the smaller curves cease to progress. However, if the curvature is greater than 45 or 50 degrees, the curve may continue to progress slowly at about one degree per year. Although that is slow progression, in 20 years that same curve will measure 65 or 70 degrees and potentially could cause breathing problems. Curves of a large magnitude will be more noticeable and can be a cosmetic concern as well.
If surgery is necessary, adolescents recover with greater ease than adults. Young people heal faster and, as they are still under the care of their parents, they will not suffer financial or other hardships required for convalescence. Most patients undergoing surgery for idiopathic scoliosis are out of school for about a month and will be back to their usual activities (including sports) within three to four months.
Roger Widmann, M.D., is Chief of Pediatric Orthopedic Surgery at Hospital for Special Surgery’s Lerner Children’s Pavilion. Julia Munn Hale, is a Pediatric Orthopedic Physician Assistant. Widmann was among the medical staff at HSS who were instrumental in creating the Pavilion, a hospital within a hospital that opened in October 2012, that provides one-stop, specialized care for children with musculoskeletal conditions.
