Scoliosis - a condition that causes the spine to curve sideways. Several different types of scoliosis affect children and adolescents; the most common type is "idiopathic" meaning the exact cause is not known.
Rarely painful, these small curves often go unnoticed by children and their parents and are first detected during a regular check-up with the paediatrician.
Slight scoliosis curves do generally not require treatment. Children with larger curves may wear a brace or have surgery to restore normal posture.
Slight curves in the back typically go unnoticed until the child starts a growth spurt during adolescence. This development may then lead to more apparent signs such as: -
- One hip higher than the other
- Uneven/tilted shoulders perhaps with one shoulder blade protruding
- The prominence of the ribs on one side
- Uneven waistline
The "Adam's forward bend test" is the standard screening test for scoliosis. Your doctor will observe your child from the back, while they bend forward, knees straight, feet together and arms hanging free. This is the position a spinal deformity is most noticeable as the Doctor looks for a difference in shape of the ribs on each side.
Additional physical checks can include: -
- Check to see if the hips and shoulders are level
- Check if the position of the head is centred over the hips
- Check the movement of the spine in all directions
To exclude other causes of spinal deformity, the Doctor may examine: -
- Limb-length discrepancies
- Abnormal neurological findings, and
- Other physical problems
These provide a clear image of the child's spine. Locating and measuring the curve allows the Doctor to determine the severity of the condition. Curves greater than 25° are considered severe enough to require treatment.
The cause of adolescent idiopathic scoliosis
About 30% of patients with adolescent idiopathic scoliosis have a family history of the condition, but doctors don't know the cause of it and have ruled out activity-related behaviours like carrying heavy backpacks or poor posture.
When planning your child's treatment, your doctor will consider factors such as:-
- Curve location
- Curve severity
- Child's age
- Growing years remaining — once fully developed, it is not common for a curve to rapidly worsen in an adolescent.
Your doctor will review these factors to determine how likely it is that your child's curve will worsen and suggest the best treatment option.
Nonsurgical Treatment of Children’s and Adolescent Deformity including scoliosis
- Monitoring - child's spinal curve is less than 25° or almost full-grown. The doctor may merely monitor the curve every 6 to 12 months to make sure it does not get worse.
- Bracing - spinal curve is between 25° and 45°, and your child is still growing, your doctor may recommend bracing. Used to prevent the curve from getting any worse that would require surgery, but unlikely to help straighten the existing curve.
Surgical Treatments for Children’s and Adolescent Deformity including scoliosis
Spinal curve 45°-50° and bracing did not prevent curve reaching this severity. Untreated the condition could affect lung function.
Spinal fusion - A spinal fusion is a surgical procedure that is done to stabilise two or more vertebrae of the spine. This involves using metalwork and bone graft (either from your body or synthetic bone). The goal is to allow the body to build bony bridges across those segments and eventually stop movement and hence pain generated by this part of the spine.