Scoliosis is a common spinal condition often found in children and adolescents. It can cause side-to-side or lateral (S or C) curvature in the backbone. Scoliosis is diagnosed when the curve exceeds 10 degrees. Curves less than this may be visual when looking at the back but are considered normal.
Anyone can get scoliosis, but there is a slightly greater risk in those who have parents or siblings with this condition. Experts don’t really know what causes scoliosis in most cases. The most common cause of scoliosis type is called idiopathic scoliosis, meaning the cause is undetermined. However, some kids develop scoliosis from birth or because of other underlying medical conditions that affect the muscles and skeletal bones. It is important to note that scoliosis is not caused by anything you or your child did. It is not caused by carrying heavy things, wearing a backpack, or any type of exercise.
Scoliosis occurs in about 1 percent to 3 percent of the population. It usually develops during periods of growth (puberty), typically between ages 10 and 12 for females and 13 and 14 for males. It can progress throughout the period of growth. It is more common in girls than in boys, especially girls who are close to getting their first menstrual period.
Most children and adolescents with scoliosis do not have symptoms. There is usually not any discomfort or change in function, and children are not limited in their activities. Patients or parents often notice a curve to the back, uneven shoulders, protruding shoulder blade when bending, or uneven hips. Back pain may present with very large curvatures.
If you notice a curve or any of these other visual findings, you should schedule an appointment with your child’s pediatrician for a full evaluation. Parents may recall a time when they, as children, were screened for scoliosis at school, likely during physical education class. Current recommendations no longer support screening for everyone. Instead, screening is now reserved for those who present with the symptoms described above.
A doctor’s examination of the spine involves proper exposure of the back and inspection for curvature of spine, difference in the height of the shoulders, asymmetry in arm hang length and waistline, and leg-length discrepancy. The examination typically involves bending forward at the waist with feet together, knees straight ahead, and arms hanging free. This examination is known as the Adams forward bend test. If scoliosis is suspected on this screening, diagnosis can be confirmed and the severity defined by an X-ray.
Even after the diagnosis is made, only a small percentage of patients require treatment. The goal of treatment is to decrease or stop progression of spinal curvature until the patient is done growing. Treatment of scoliosis also depends on the severity of the curve and the age of the child. Mild cases of scoliosis, less than 25 degrees of curvature, may not need treatment but just close follow-up. Severe scoliosis, especially with complications interfering with daily activities, may need surgical treatment.
Overall, treatment options can include: no treatment, watchful waiting, bracing, and surgery.
- No treatment is required if your child has finished growing and there is minimal curvature of the spine.
- Watchful waiting is for children who have not finished growing and have mild curvature of the spine, usually less than 30 degrees. The severity of the curve is followed by repeating X-rays occasionally until skeletal maturity is reached.
- The most common non-operative treatment is bracing. Bracing does not straighten the spine, but it helps prevent progression of the curve as the child grows. Bracing is suggested when a patient’s curve is between 30 degrees and 39 degrees and the spine in still maturing. The brace is custom-made and fit for your child. It wraps around the torso and is worn about 18 hours a day. The brace is relatively easy to hide under clothing.
- Surgery may be needed if the curvature of spine is enough to cause pain or dysfunction. It may also be needed if the curvature of the spine is greater than 50 degrees or if it continues to gets worse after growth is complete. The surgery involves joining the bones of the spine together, also known as fusion, to help them line up correctly.
Rest assured, most people with scoliosis go on to live a normal life without any long-term complications. Scoliosis should not limit activities and children and adolescents can maintain living a normal active lifestyle with family, school and extracurricular activities.
Dr. Carolyn Kienstra is a pediatric sports medicine physician with the University of Miami Sports Medicine Institute. Dr. Alicia Morrisson is a PGY-1 (first year) pediatric resident in the University of Miami Miller School of Medicine who sees patients at Holtz Children’s Hospital. For more information, umiamihealth.org/treatments-services/pediatrics.