• Scoliosis—Child

    Definition

    Scoliosis is an abnormal curvature of the spine, or backbone. Instead of a straight vertical line from the neck to the buttocks, the spine has a C- or S-shape.
    Types of scoliosis include:
      Structural—curvature with spinal deformity:
      • Congenital
      • Syndromic
      • Idiopathic
    • Functional—curvature without spinal deformity
    Scoliosis may also be described as infantile, juvenile, or adolescent based on the child's age at onset.
    Scoliosis
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    Causes

    The different types of scoliosis have different causes.
    Structural scoliosis—classified by the cause of the vertebral body defect:
    • Congenital—defect occurs during fetal development
    • Syndromic—defect occurs as a result of an underlying health condition that affects the nerves, muscles, or bones in the back and spine
    • Idiopathic—defect occurs without a specific cause, but is likely due to a combination of multiple genetic factors
    Functional scoliosis may be caused by:
    • Muscle imbalances
    • Differing leg lengths
    • Conditions that cause muscles to remain tense and spasm
    In some cases, scoliosis may be caused by damage to the vertebral body from:
    • Injury
    • Infection
    • Tumors

    Risk Factors

    Factors that may increase your child's risk of developing syndromic scoliosis include having conditions that affect muscles and nerves, such as muscular dystrophy or cerebral palsy .
    Idiopathic scoliosis is more common during the rapid growth phase of adolescence. Family history of scoliosis may also increase your child's chance of developing scoliosis.
    Girls are more likely to have more severe curves. Scoliosis severity may also be influenced by:
    • Delayed puberty in boys and girls
    • Delayed first period in girls

    Symptoms

    In most cases, scoliosis doesn't have symptoms that can be felt. It is generally detected during a screening test, but may be noticed by the child or another person.
    Some schools have scoliosis screening programs . If scoliosis is detected in school, you will be advised to follow-up with your doctor.
    Scoliosis may cause:
    • Uneven shoulders
    • Prominent shoulder blade or ribs
    • Uneven waist
    • An elevated hip
    • Leaning to one side
    • Chronic back pain—rare in teens, but more common in adults
    More severe cases of scoliosis can lead to:
    • Body image issues
    • Breathing difficulties due to pressure on the lungs and heart from a compressed rib cage
    • Rarely, cor pulmonale—right-sided heart failure caused by high blood pressure in the arteries of the lungs

    Diagnosis

    You will be asked about your child's symptoms and medical history. A physical exam will be done. Scoliosis can be diagnosed on examination of the back and spine. The exam may include:
    • Assessing posture and spinal curvature in the upright position
    • Adam's forward bend test to:
      • Look at spinal curvature
      • Detect imbalances in the rib cage
      • Look for other abnormalities along the back
    • Pattern of movement while walking
    • Checking the skin to look for abnormal lesions
    • Scoliometer—a measurement device used to assess the curvature and rotation of the spine
    X-rays are usually done to:
    • Check the severity of scoliosis by measuring the Cobb angle
    • Detect vertebral or structural abnormalities
    • Assess level and pace of bone development.
    Your child's doctor may recommend other tests to see if the scoliosis is caused by an underlying health condition.

    Treatment

    Functional scoliosis is reversible with treatment of the underlying condition.
    Children with structural types of scoliosis will be referred to a spinal specialist if treatment is needed.
    Scoliosis treatment depends on many factors. These include:
    • Severity of the curve
    • Child's age
    • Child's stage of growth
    • If back pain is involved, or other if your child has other symptoms
    In general, children with a mild curve are treated with observation. This means your child will have regular follow-up exams and sometimes x-rays to see if the curve worsens. Frequency of follow-up appointments depends on age, stage of growth, and the severity of the curve. Physical therapy may be helpful to manage pain and optimize your child’s function.
    Other treatment methods include:

    Bracing

    The goal of bracing is to prevent curves from getting worse. The doctor may recommend that your child wear a back brace if they are still growing and the curve is more than 20 degrees, but less than 40 degrees. Once growing stops, the need for more treatment will depend on the size of the curve and how it affects your child's appearance and function. Physiotherapy scoliosis specific exercises may also be advised.
    Bracing may not be helpful in girls who have had their period for more than a year, in children who have attained full growth, or are within one year of full pelvic bone growth.
    Bracing will feel uncomfortable at first. Children will need lots of support to wear the brace as prescribed, as well as encouragement to foster a positive body image.

    Surgery

    In severe cases where the curvature is greater than 40 degrees, your child's doctor may recommend surgery to lessen the curve or stop it from worsening if they are still growing. If they are done or almost done growing, it will be recommended for a curve greater than 50 degrees.
    Surgery typically involves fusing the vertebrae of the spine together or the use of internal rods to decrease the curvature. Hospitalization can last 5-7 days. Recovery can take several months. Surgical techniques using stapling methods or implants, as well as other surgical techniques, are also available, but some are still experimental.

    Prevention

    There are no current guidelines for preventing scoliosis because the cause is usually unknown.

    RESOURCES

    Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    Scoliosis Research Society http://www.srs.org

    CANADIAN RESOURCES

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Adolescent idiopathic scoliosis: an overview. Hospital for Special Surgery website. Available at: https://www.hss.edu/conditions%5Fadolescent-idiopathic-scoliosis-overview.asp. Updated February 28, 2011. Accessed December 1, 2015.

    Altaf F, Gibson A, et al. Adolescent idiopathic scoliosis. BMJ. 2013;346:f2508.

    Idiopathic scoliosis in children and adolescents. Ortho Info—American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Updated March 2015. Accessed December 15, 2015.

    Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews. 2015;6:CD006850.

    Scoliosis. American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=44c972bb-9690-4505-99f2-0a4c6d1a41a4#.VnBY1L8TDOs. Accessed December 1, 2015.

    Adolescent idiopathic scoliosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 8, 2015. Accessed December 15, 2015.

    Scoliosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scoliosis/default.asp. Updated July 2013. Accessed December 15, 2015.

    Scoliosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scoliosis/scoliosis%5Fff.asp. Updated November 2014. Accessed December 15, 2015.

    4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.

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