Scoliosis in Children and Adolescents

Many schools regularly conduct scoliosis screenings among students. Usually these screenings occur during the middle school years. If your child receives a referral for scoliosis based on a school screening, here are some facts you should know.


Scoliosis

• Is a sideways curvature of the spine that makes the spine look more like an "S" or "C" than a straight "I".
  
  
• Can cause the bones of the spine to turn (rotate) so that one shoulder or hip appears higher than the other.
  
  
• Can run in families, although the exact cause of most cases of scoliosis is unknown (idiopathic).
  
  
• Can occur at any age. Infantile scoliosis occurs in children less than 3 years old, and may result from a birth defect, disease of the nerves and muscles (such as muscular dystrophy or cerebral palsy), injury, infection or tumors. Juvenile scoliosis occurs in children between the ages of 3 and 10 years old and is not common. Adolescent scoliosis occurs after the age of 10 years old and is the most common type.
  
  
• Does not usually cause any pain.
  
  
• Occurs about equally in boys and girls, but girls are more likely to have a severe, progressive curve that will require treatment.
  

• Requires a thorough medical history to determine if any other problems may be causing the spine to curve.
  
  
• Includes a comprehensive physical examination. The doctor will ask your child to bend forward, which will show any deformities. He or she will also check for any limb-length discrepancies, abdominal muscle strain or other potential causes.
  
  
• Is confirmed with an x-ray of the spine. The physician will measure the degree of the curve as shown on the X-ray. The type of treatment required depends on the kind and degree of the curve, the child's age, the number of years of growing until the child reaches skeletal maturity and the type of scoliosis.
  

• Observation: This option may be appropriate if the angle of the curve is not severe (less than 20 degrees) or if the child is near skeletal maturity. However, the doctor will want to recheck the curve on a regular basis to see that it is not getting any worse. He or she may ask that you come back every 3 to 6 months for re-examination. Most cases of scoliosis referred through school screening will fall into this category.
  
  
• Bracing: The goal of bracing is to prevent curves from getting worse. Bracing can be effective if the child is still growing and has a curve of less than 30 degrees. There are several types of braces that reach to the underarm or higher. Your orthopaedist will recommend a brace and tell you how long it should be worn each day. Wearing a brace does not affect participation in activities such as sports or exercise.
  
  
• Surgery: If the curve is more than 50 degrees and the child is still growing, the doctor may recommend surgery. Before the operation, your child can donate some of his or her own blood to reduce the risk of infection. The surgery requires a bone graft from the hip, ribs or a bone bank and may use a series of rods, hooks, screws or wires to straighten the spine. Patients can walk about on the second or third day, are discharged from the hospital within a week and can rapidly resume their daily activities. A return to some sports is possible in 6 to 9 months.