Scoliosis

Overview

Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. While scoliosis can occur in people with conditions such as cerebral palsy and muscular dystrophy, the cause of most childhood scoliosis is unknown.

Most cases of scoliosis are mild, but some curves worsen as children 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 straighten severe curves.

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
• One side of the rib cage jutting forward
• A prominence on one side of the back when bending forward

With most scoliosis cases, the spine will rotate or twist in addition to curving side to side. This causes the ribs or muscles on one side of the body to stick out farther than those on the other side.

When to see a doctor

Go to your doctor if you notice signs of scoliosis in your child. Mild curves can develop without you or your 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 sometimes runs in families. Less common types of scoliosis may be caused by:

• Certain neuromuscular conditions, such as cerebral palsy or muscular dystrophy
• Birth defects affecting the development of the bones of the spine
• Previous surgery on the chest wall as a baby
• Injuries to or infections of the spine
• Spinal cord abnormalities

Risk factors

Risk factors for developing the most common type of scoliosis include:

• Age-: Signs and symptoms typically begin in adolescence.
• 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:

• Breathing problems-: In severe scoliosis, the rib cage may press against the lungs, making it more difficult to breathe.
• Back problems-: People who had scoliosis as children may be more likely to have chronic back pain as adults, especially if their abnormal curves are large and untreated.
• Appearance-: As scoliosis worsens, it can cause more noticeable changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.

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. Repeated radiation exposure can become a concern because multiple X-rays will be taken over the years to see if the curve is worsening.

To reduce this risk, your doctor might suggest a type of imaging system that uses lower doses of radiation to create a 3D model of the spine. However, this system isn't available at all medical centers. Ultrasound is another option, although it can be less precise in determining the severity of the scoliosis curve.

Magnetic resonance imaging (MRI) might be recommended if your doctor suspects that an underlying condition — such as a spinal cord abnormality — is causing the scoliosis.

Treatment

Scoliosis treatments vary, depending on the severity of the curve. Children who have very mild curves usually don't need any treatment at all, although they may need regular checkups to see if the curve is worsening as they grow.

Bracing or surgery may be needed if the spinal curve is moderate or severe. Factors to be considered include:

• 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. Bone maturity can be checked with hand X-rays.
• Severity of curve. Larger curves are more likely to worsen with time.
• Sex. Girls have a much higher risk of progression than do boys.

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 the curve from getting worse.

The most common type of brace is made of plastic and is contoured to conform to the body. This brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.

Most braces are worn between 13 and 16 hours a day. 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 when there are no further changes in height. On average, girls complete their growth at age 14, and boys at 16, but this varies greatly by individual.

Surgery

Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse.

Surgical options include:

• Spinal fusion-: In this procedure, 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.
• Expanding rod-: If the scoliosis is progressing rapidly at a young age, surgeons can attach one or two expandable rods along the spine that can adjust in length as the child grows. The rods are lengthened every 3 to 6 months either with surgery or in the clinic using a remote control.
• Vertebral body tethering-: This procedure can be performed through small incisions. Screws are placed along the outside edge of the abnormal spinal curve and a strong, flexible cord is threaded through the screws. When the cord is tightened, the spine straightens. As the child grows, the spine may straighten even more.