Scoliosis is a disorder that causes an abnormal sideways curvature of the spine. If you look closely the average back, you will see that the spine runs straight down the middle. However, if the person has scoliosis, their backbone curves to the side. The angle of the curve can vary in degree and severity but anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.
Most cases of scoliosis are mild with few symptoms but is about two times more common in girls than boys. While scoliosis can appear at any age, it most commonly occurs during the growth spurt just before puberty.
During a pediatric physical exam, the doctor may have the 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.
A general x-ray can confirm the initial diagnosis of scoliosis and reveal the severity of the spinal curvature. If the doctor suspects that an underlying condition, such as a tumor, is causing the scoliosis, then they will likely recommend an MRI.
In planning a child’s treatment, the doctor will take into account the severity of the curve, gender, maturity of growth and the location of the curve as well as the curve pattern.
Most children with scoliosis have mild curves and probably will not be affected by the condition enough to need a brace or surgery. Children who have been diagnosed with mild scoliosis should go in for regular checkups to see if there have been changes in the curvature of their spines.
Most orthopedic surgeons agree that children who have very severe curves (50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.
While there are general guidelines for each stage of severity in curves, the decision to begin treatment is always made on an individual basis. Factors to be considered include:
- Severity of Curve: Larger curves are more likely to worsen with time
- Gender: Girls have a much higher risk of experiencing progression than boys
- Maturity of Growth: If the child’s spine is still growing, it will affect treatment choices
- Location of Curve: Curves in the center of the spine worsen faster than curves in the upper or lower sections
- Curve Pattern: Double curves, also known as S-shaped curves, tend to worsen more often than C-shaped curves
In general, there are two treatment options for scoliosis, a brace or surgery.
Your doctor may recommend a brace if your child’s bones are still growing and he or she has moderate scoliosis. A brace can prevent further progression of the curvature in the spine but is not a cure for scoliosis.
The most common type of brace is made of plastic and is contoured to conform to the body so it is nearly undetectable under the clothes.
Depending on the severity of the curve at diagnosis, it may need to be worn at all times. A brace’s effectiveness increases with the number of hours a day it is worn. Children who wear braces can usually participate in most activities and have few restrictions as they can remove the brace while participating in sports and other physical activities as needed.
Most surgeons do not want to put children through surgery, but in the case of severe scoliosis that can progress through time, it is sometimes the only option that will reduce the severity and prevent it from getting worse. The most common type of scoliosis surgery is spinal fusion.
Lumbar spinal fusion is an operation that causes the vertebrae (bones of the spine) in the lower back to grow together. The goal of the lumbar fusion is to prevent the vertebrae from moving independently. Removing the intervertebral disc (cushion between the bones) or bone spurs can reduce some of the pressure on the nerves, helping to reduce pain. Additionally, 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.
Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal which means another surgery may be needed.
Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.
To learn more about treatment options or to schedule an appointment with one of our spine specialists, call us at 800.698.1280.