Pediatric and Adolescent Scoliosis

What is pediatric and adolescent scoliosis?

Pediatric and adolescent scoliosis is a condition in which a child’s spine abnormally curves sideways or rotates. Scoliosis can range from mild to severe. People with mild scoliosis may only need to be seen by their doctor on a regular basis. Those with more severe cases may need braces or surgery.

Who gets pediatric and adolescent scoliosis?

About 2% of the population is affected by scoliosis. Scoliosis can affect people of any age, but it is most common in adolescents.

What causes pediatric and adolescent scoliosis?

There are three different types of pediatric and adolescent scoliosis:

• Idiopathic scoliosis is the most common type. "Idiopathic" means that the cause is unknown, but because it runs in families, it has a genetic (hereditary) basis.
• Congenital scoliosis is a fairly rare spine abnormality detected at birth.
• Neuromuscular scoliosis is a curvature of the spine caused by abnormalities in the muscles and nerves that support the spine. Examples include patients with cerebral palsy, spina bifida and muscular dystrophy.

What are the symptoms of pediatric and adolescent scoliosis?

Scoliosis usually causes no pain, so symptoms can often go unnoticed. Parents or caregivers should watch for the following signs in their child:

• Uneven shoulders.
• Constant leaning to one side.
• Uneven leg length.
• Prominent shoulder blade(s).
• An uneven waist.
• Elevated hips.

If you notice any of these signs in your child, contact your doctor to have your child screened.

How is pediatric and adolescent scoliosis diagnosed?

If you or a caregiver or teacher thinks your child may have scoliosis, contact your doctor as soon as possible. The doctor should also be screening for scoliosis on a regular basis and may be the first to suspect the condition.

An evaluation for scoliosis has several steps:

• Your doctor will usually begin with a thorough history to determine if there is a family history of scoliosis. The history will also be used to screen for birth defects or trauma that may explain the curvature of the spine.
• The doctor will then conduct a physical examination of your child's back, chest, pelvis, legs, feet and skin. The doctor will be looking to see if the child’s shoulders are level, whether the head is centered and whether opposite sides of the body look level.
• The doctor will then ask the child to bend forward so that the back muscles can be examined, and to see if one side of the rib cage is higher than the other.
• While checking the limbs, the doctor will be evaluating whether the limbs are the same length. He or she will also check for abdominal muscle strain, which could cause spinal curvature.
• After a physical examination, the doctor may order an X-ray of the spine to confirm a diagnosis of scoliosis. The X-ray will be taken with your child standing so that the entire spine can be seen. The doctor will then measure the curves of the spine as shown on the X-ray. Curves that are greater than 25 degrees may require treatment.

If your doctor determines that your child has scoliosis, he or she will refer you to an orthopaedic spine specialist for treatment.

How is pediatric and adolescent scoliosis treated?

The treatment for pediatric scoliosis depends on several factors:

• The type of scoliosis.
• The kind and degree of the curve.
• Your family history of scoliosis.
• Your child's age.
• The number of remaining growth years your child has until skeletal maturity.

Most children with scoliosis will have mild cases that only require monitoring every four to six months.

If your child's doctor notices that the spinal curve is getting worse, he or she may prescribe the use of a custom brace to prevent it from progressing even more.

If the brace does not control the spinal curve, or if the curve is severe when the child is first seen, surgery may be necessary. This is usually recommended when the spinal curve is more than 45 degrees. Surgery has been found to be a very effective treatment for severe scoliosis.

Can my child with scoliosis still exercise and participate in physical activity?

Yes. While it will not cure scoliosis, exercise might lessen any potential reduction in your child’s physical function over time. Keeping physically fit and exercising can also improve your child's overall sense of well-being and happiness.

Can playing sports can make my child's scoliosis worse?

Adolescent idiopathic scoliosis, the most common type of scoliosis, often occurs between the ages of 10 and 16 — just when many children are eager to jump in to a smorgasbord of middle school and high school sports and athletic programs.

But don’t despair. Playing sports won’t make scoliosis worse. In fact, participating in sports that promote flexibility and core strength can actually reduce your child’s back pain. Sports that can help scoliosis include:

• Swimming, which can increase core strength since it requires your child to use all of his or her muscles at once.
• Gymnastics, which can boost your child’s flexibility and improve core strength.

Should my child should avoid certain sports?

Most sports, even weightlifting, are generally fine. However, if a child has had back surgery, they should avoid contact sports. These include hockey, lacrosse, wrestling and football.

For sports such as basketball, soccer, tennis and swimming, your child can probably start participating in them again about six months after surgery. But be sure to talk with your child’s doctor first.