Scoliosis Awareness Month in June is an opportune time to discuss treatment advances and the importance of early diagnosis. Scoliosis refers to an abnormal curvature of the spine, and it tends to run in families.
The most common type is called “idiopathic scoliosis,” which means the cause is not known. Scoliosis is not caused by poor posture, the use of backpacks or any type of exercise. It is usually diagnosed after age 10 and affects more girls than boys.
Many cases of scoliosis are mild, and periodic checkups are all that a child needs. However, youngsters with a curve that continues to increase may need treatment.
Signs of Scoliosis
Scoliosis is often detected during a routine visit to the pediatrician. Some schools conduct screenings for the condition and may send a student for follow-up with a physician. The development of scoliosis is usually gradual and painless. A curve can develop without a parent or child knowing it until it becomes more pronounced.
Viewed from behind, a normal spine appears as a straight line from the base of the neck to the tailbone. Signs of scoliosis:
- one shoulder appears higher than the other
- the waist appears uneven
- one hip looks higher than the other
- the ribs appear to protrude on one side
- the child seems to be leaning to one side when standing
Parents who notice any sign of scoliosis, however subtle, should take the child to the doctor. If a youngster does have the condition, an early diagnosis and proper treatment result in a better outcome and can prevent it from getting worse. Untreated scoliosis may eventually lead to back pain, and although rare, severe cases can affect the heart and lungs in adulthood later on.
Diagnosis of Scoliosis
The diagnosis is based on a physical examination and x-rays. Treatment depends on the age of the child, the degree of the curve and how much the youngster will continue to grow. For patients with smaller curves, the pediatric orthopedist often recommends regular doctor visits to monitor the child’s spine. For more significant curves, the most common treatment is a back brace.
Advances in Braces to Treat Scoliosis
Bulky back braces to treat scoliosis are a thing of the past. Nowadays, lightweight, custom-braces with padding are much more comfortable and can even be undetectable under clothing. I often tell patients and their parents that becoming accustomed to the brace is kind of like buying a new pair of shoes. They should break it in slowly so it becomes comfortable over time. It may take a couple of weeks, but most young people will get used to it.
Some braces are worn throughout the day and evening, and others are worn only during sleep. Studies show that the brace usually does not need to be worn around the clock. Young people can generally have about eight hours during the day to engage in activities they enjoy without wearing the brace.
However, it’s very important for the child to wear the brace as instructed. For children with a positive attitude who diligently wear their brace, the success rate of treatment is 75 to 80 percent. It’s also very important for parents to have a positive attitude, as this sets the stage for a how a child or teen will react. The brace is generally worn during the patient’s growing years.
Three-Dimensional Scanning for Brace Measurement
Over the past year or so, we’ve seen a major advance in how people are measured for their brace. Traditionally, a plaster cast was molded around the patient to use as a model for brace fabrication. At HSS, many patients now benefit from a new computerized scanner that obtains a three-dimensional image with a high degree of accuracy for optimal fit. While the patient is in a standing position, in a matter of minutes a digital scanner captures the images that will be used to design a customized brace. Clearly, this process is much quicker and easier than putting the patient in a plaster cast.
Advances in Scoliosis Surgery
For patients with more advanced scoliosis, surgery may be recommended. For younger children, a revolutionary advance entails the use of surgically implanted magnetic rods that can be lengthened with an external remote control right in the doctor’s office. This is important for a growing child.
The technique entails placing a powerful magnet on the patient’s back to painlessly expand the rods in a matter of minutes. In essence, the magnetic rods grow along with the child, eliminating the need to return to the operating room every six months or so for a new procedure.
Beware of Unproven Scoliosis “Treatments”
Parents are advised to beware of unproven treatments and devices purported to cure scoliosis. Appearing online and often touted as the “latest and greatest,” these supposed remedies are not approved by the Food and Drug Administration, are not covered by insurance and may ultimately do more harm than good. Ineffective therapies also delay timely treatment of scoliosis. By the time the patient sees a qualified specialist, a more extensive procedure – even surgery – may be needed.
Dr. John S. Blanco is a pediatric orthopedic surgeon at Hospital for Special Surgery’s Lerner Children’s Pavilion. He specializes in scoliosis correction (anterior and posterior), clubfoot correction, pediatric fracture management, and management of neuromuscular conditions. Throughout his career, Dr. Blanco has published numerous articles on a variety of topic including scoliosis, pediatric fracture management, slipped capitol femoral epiphysis and cerebral palsy.