Avoiding scoliosis and maintaining good posture are universal concerns among parents today. Many of these parents may be surprised to know that small curves are a normal part of spine anatomy. Julia Hale, Physician Assistant Pediatric Orthopedics, and the Pediatric Orthopedic Surgery Department at Hospital for Special Surgery provides an overview on the importance of early detection of scoliosis in children for National Scoliosis Awareness Month:
1. Scoliosis is usually detected by a pediatrician, school nurse during school screening or parent (often times some asymmetry of the rib cage may be noted while a child is in a bathing suit or when trying on clothes). A child with scoliosis may have a protruding scapula or uneven hips, where one leg appears longer.
2. Children with suspected scoliosis should see a pediatric orthopedist who can confirm the diagnosis with physical examination and x-rays. A curve of greater than 10 degrees on x-ray is considered to be scoliosis. At HSS, in children younger than ten years of age, an MRI of the entire spine is recommended. According to Dr. Daniel Green, pediatric orthopedic surgeon, “In some cases, even though the vertebral bones may be healthy, the spinal cord may not be.” MRI images can help the orthopedist detect the presence of other problems such as syrinx, a cyst in the spinal cord, or tethered cord, in which the spinal cord is abnormally attached to the bony spine.
3. Scoliosis is diagnosed as one of three types: idiopathic, of unknown origin; congenital scoliosis, in which the bones are asymmetrical at birth and the vertebrae may be partially formed (hemi-vertebra) or wedge-shaped; and neuromuscular scoliosis, in which the scoliosis is symptomatic of a systemic condition such as cerebral palsy, muscular dystrophy, or paralysis.
4. In all its forms, early diagnosis of scoliosis is a primary goal. Treatment is guided by the specific scoliosis type, the amount of growth the child has left, the degree of the deformity, and anticipated progression of the condition. Children with infantile and juvenile scoliosis have the greatest risk of curve progression, as well as the greatest risk of developing secondary pulmonary complications from scoliosis, explains Dr. Roger F. Widmann, Chief of Pediatric Orthopedic Surgery at HSS.
Stay tuned on Thursday for more information on treatment options for scoliosis by Dr. Matthew Cunningham, Spine Surgeon.
Julia Munn Hale is a certified physician assistant in the Pediatric Orthopedic Surgery Service at Hospital for Special Surgery.