What is Scoliosis?
Scoliosis is an abnormal, sideways curvature of the spine. It is often diagnosed between infancy and early adolescence.
Key facts
- Your child may be born with scoliosis or can develop it later in life
- Typically, the primary age of onset for scoliosis is 10-15 years old
- The curve can happen on one or both sides of the spine
- The curve is usually C-shaped, and can also be S-shaped
- The angle of the curve can be up to 45 degrees
- It is seen more commonly in girls
Spine Anatomy
Your child’s spine comprises three main parts: the neck (cervical spine), the chest and mid-back (thoracic spine), and the lower back (lumbar spine). The spine is made up of bones called vertebrae which are stacked one upon the other like blocks forming a vertical line in the back.
In scoliosis, the vertebrae curve to one side and rotate or twist, making your child appear to lean to one side.
Types of Scoliosis
- Idiopathic: Scoliosis caused by unknown factors
- Congenital: This tends to run in families. It occurs when the spine does not develop properly in the womb.
- Neuromuscular: Certain disorders of the brain, spinal cord, and muscular system can result in scoliosis (for example, cerebral palsy or muscular dystrophy)
Also injuries, infections or tumors (rare) of the spine can cause scoliosis.
Symptoms
Most cases of scoliosis are mild and do not affect your child’s appearance or health and does not cause any pain or interfere with their everyday activities.
However, in some children the condition may become worse as they grow leading to more severe scoliosis which can be painful and disabling. This may result in back pain, physical limitations and other health problems.
Other noticeable symptoms can be:
- Your child’s spine curving side to side
- Uneven hips, waist and shoulders
- A shift of the waist and trunk to the side
- Head not centered directly above the pelvis
- Muscle spasms, prominent ribs of the chest
- Trouble walking/standing up straight
- Fatigue, shortness of breath
- Numbness, weakness, or pain in the legs
Diagnosis
Early diagnosis is key for the treatment of scoliosis. The doctor will initially take a detailed growth and medical history of your child.
This is followed by a physical examination where the doctor may have your child stand and then bend over to assess their spinal column. The examination also involves looking at the curve of the spine from the sides, front, and back. A neurological exam may also be conducted to check for muscle weakness.
Additionally, imaging tests such as an X-ray, an MRI scan or a CT scan can be ordered to confirm the diagnosis and determine the severity of the spinal curvature.
Non-operative Scoliosis Care
Non-operative treatment methods for scoliosis may involve any of the following:
- Observation: No treatment is required if your child has a spinal curvature of less than 20 degrees. Observation is the standard of care in such cases where your physician will monitor the spine with regular follow-ups and X-rays from time to time until your child has achieved full growth around late puberty to ensure the curve is not progressing and that other health issues do not develop. If your child's curvature progresses beyond 20 degrees, then your physician may recommend physical therapy or bracing to avert additional curving.
- Physical Therapy: Physical therapy is employed if your child is undergoing pain due to the curvature of the spine. During physical therapy, your therapists will design a customized program for your child to strengthen the back and leg muscles to increase flexibility and avert injury. Your therapist will use standard flexibility techniques and focus on your child's core muscles or try manual therapy, in which your therapist will manually guide and retrain your child’s movements. Even though physical therapy does not rectify the curvature, it can help to lessen your child's discomfort and pain.
- Bracing: Bracing is recommended to prevent the progression of the scoliotic curve. It is effective in growing children with a spinal curvature between 20 and 40 degrees. A health care professional known as an orthotist will provide a custom-made brace for your child and work closely with your doctor to ensure a proper fit and comfort. Although a brace does not rectify an existing curvature, it can certainly prevent it from becoming worse as your child grows. For the brace to work effectively, your child should typically wear the brace for at least 18 hours a day.
- Casting: For infants and toddlers with severe curvature, your physician may employ plaster casting treatment instead of bracing to assist the child’s spine to develop into proper position. An orthotist applies a cast around the child's chest and back utilizing a special technique designed to rectify the spine deformity over time. The cast needs to be worn at all times and changed every 2 to 3 months as the child develops. A minimum of 5 cast changes may be required at regular intervals as part of this treatment method as most children grow rapidly.