Scoliosis in Children

What is scoliosis?

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater on x-ray. 

Scoliosis is a type of spinal deformity and should not be confused with poor posture. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis.

What causes scoliosis?

In most cases, the cause of scoliosis is unknown – a condition called idiopathic scoliosis. Scoliosis is more common in females than males. 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five out of every 1,000 children develop spinal curves that are considered large enough to require treatment.

The American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research Society, describe three different types of scoliosis that can occur in children - congenital (present at birth), neuromuscular, or idiopathic.

Adolescent Idiopathic Scoliosis occurs in children from 10 to 18 years of age. This is the most common type of scoliosis and is more commonly seen in girls.

What are the symptoms of scoliosis?

The following are the most common symptoms of scoliosis. However, each child may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head is not centered with the rest of the body
• difference in hip height or position
• difference in shoulder blade height or position
• when standing straight, difference in the way the arms hang beside the body
• when bending forward, the sides of the back appear different in height

How is scoliosis diagnosed?

In addition to a complete medical history and physical examination, xrays are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician or nurse practitioner measures the degree of spinal curvature on the x-ray.

The following other diagnostic procedures may be performed for non idiopathic curvatures, atypical curve patterns, or congenital scoliosis:

• magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present

Treatment of Scoliosis

Specific treatment of scoliosis will be determined by your child's physician or nurse practitioner based on:

• your child's age, overall health, and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

• observation and repeated examinations
• bracing
• surgery
  

Le Bonheur Children’s Medical Center has pediatric orthopaedic surgeons who specialize in the spine. There are also clinics dedicated to the treatment of scoliosis. These clinics have attending physicians, nurse practitioners, residents, orthopaedic nurse coordinators, orthotists, and orthopaedic nurses trained to provide quality care, answer your questions, and provide family centered care to you and your family.

Young children or those with severe spinal deformities with severe spinal deformities may be treated with a vertical expandable prosthetic titanium rib (VEPTR). A VEPTR is a metal rod curved to fit the back of the chest and which is lengthened to grow with the child. During a surgical procedure it is attached to the rib cage or pelvis to help the spine become straighter allowing for improved breathing and lung development.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.

Long-term outlook for a child with scoliosis

The management of scoliosis is individualized for each child depending on his/her age, amount of curvature, and amount of time remaining for skeletal growth. Scoliosis will require frequent examinations by your child's physician or nurse practitioner to monitor the curve as your child grows and develops. Early detection is important. If left untreated, scoliosis can cause problems with heart and lung function.

Why Le Bonheur Children's?

The orthopedic surgeons at Le Bonheur Children's Medical Center are some of the most well respected pediatric surgeons in the United States. The hospital's Spine Institute is a center of excellence dedicated to the treatment and research of all pediatric spinal conditions including deformities, fractures, infections and tumors. Children from across the country visit Le Bonheur each year to be treated at the Institute.

Posted: Fri Dec 05 00:00:00 CST 2008 For more information please contact: Neuroscience Institute , 866.705.8279