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Scoliosis
Identifying and correcting a disfiguring condition

Scoliosis is a potentially serious spinal disorder that affects many children especially those between ages eight and 18.

Since the condition may not be detected when children are very young, detection programs used to be held at school by the public health nurse. If a child was found to have scoliosis, the information was sent home to the parents. As this school program is no longer available, other means must be found to make families aware of the need to detect scoliosis. Your family doctor can be a big help in watching for this important problem.

What is scoliosis?

Scoliosis is an abnormal curvature of the spine to one side. In many cases individual vertebrae rotate. If it is allowed to progress, severe deformity of the spine and rib cage may cause problems with heart and lung function. As many as one in ten children may develop some degree of scoliosis.

What causes scoliosis?

The cause depends on the type of scoliosis.

• The most common type is known as Idiopathic Scoliosis. Idiopathic means no cause can be found for a condition so this diagnosis is made when all other causes are ruled out. Many factors including genetics and hormones may be involved.
• Congenital Scoliosis means abnormal development of the spinal vertebrae is present at birth. Bracing may be recommended. Surgery is sometimes required.
• Neuromuscular Scoliosis results from muscular imbalance such as muscular dystrophy or neurological disorders such as cerebral palsy.
• Kyphosis is commonly known as a humpback. In this case, the normal curve of the upper back is exaggerated. It is most often a problem with posture and may be corrected with proper exercise and postural training. Kyphosis, if progressive and severe, can cause serious complications.
• Adult Scoliosis is the aftermath of adolescent scoliosis. Aging may cause a once stable curve of 45 degrees or over to progress.

How is scoliosis discovered?

• There are several ways that scoliosis may be detected.
• Family doctors may discover it during a routine examination.
• Parents may notice that their child has:
  • poor posture
  • one shoulder appearing lower than the other
  • clothes that do not hang properly
  • one shoulder blade that appears more prominent than the other
  • uneven hips.
• Physical education teachers, sports and dance instructors may notice unusual changes in the child’s body.

Can I check my child for scoliosis?

Yes. There is a specific way to check. Have your child bend forward. By looking down your child’s back you may notice that one side of the rib cage appears higher than the other. This may indicate scoliosis and your child should be seen by your family doctor.

What happens if my family doctor finds that my child has scoliosis?

Your family doctor may refer the child to an orthopedic specialist. The specialist will examine your child to confirm the diagnosis and to rule out other factors that may be involved. X-rays will usually be taken to view the spine and as a basis for comparison with future x-rays to watch for changes in the spinal curve. Your child may need a couple of x-rays per year. These will be low dose x-rays to limit the total radiation exposure. The amount of rotation of the spine can be measured by an instrument called a scoliometer and the result recorded in degrees.

A back shape video image may be taken of the back. The image is recorded and used as a comparison with future images to show if changes to the trunk have occurred. A light pattern may be projected on the back. This projected image is used to obtain 3-D images of the back.

An MRI (Magnetic Resonance Imaging) scanner may be required to determine if there are any soft tissue or neurological problems.

What is the risk that the spinal curve will increase?

The younger the age that your child develops scoliosis the greater the risk of increase. If your child is diagnosed at the age of 10 with a rotation measurement of more than 20 degrees, the risk of the curve increasing is high.

How is scoliosis treated?

The current methods of treating severe idiopathic scoliosis include bracing or surgery. If the spinal curve is under 20 degrees, your child will be examined regularly by the orthopedic specialist to monitor the condition.

Bracing

If the curvature is over 20 degrees, an upper body brace may be recommended. The brace is composed of a hard plastic material similar to that used in protective hockey equipment. An orthotist (brace fabricator) will custom-fit the brace to your child. Padding is placed on the inside of the brace at any location where pressure needs to be applied to the rib cage.

The theory behind this type of bracing is that your child will naturally pull away from these pressure points and therefore force the spine to assume a corrected position. The brace may be required up to 20 hours per day during the child’s years of growth. Bracing may be successful in halting the progression of the spinal curvature.

Corrective surgery for ideopathic scoliosis

Surgery is usually advised when the spinal curvature is over 50 degrees. About 25 per cent of those children receiving active treatment will require surgery.

Surgery may be done in an effort to stop the curvature from increasing. Without surgery the curve may continue to the point where there is severe deformity of the rib cage, endangering the functioning of heart and lungs.

The rotation of the vertebrae may cause one side of the rib cage to rotate backward. This backward rotation may result in a bump appearing on one side of the back. If the bump is very large, it may be reduced by a surgical procedure known as costoplasty. Surgery permits the ribs to assume a more normal position and usually improves the appearance of the back.

Surgery to correct spinal curvature involves the use of rods, hooks, wires or screws (spinal instrumentation). This instrumentation is attached to the spine and the curve is corrected as much as possible. A thin layer of bone graft material is then placed on the corrected spine. This bone eventually becomes one with the spine and acts to hold the spine in its corrected position.

The child usually returns to school within three months and can participate in most activities after a year. The success rate of spinal instrumentation surgery is high.

Occasionally, problems may occur due to:

• Incomplete fusion of the spine,
• continued growth of an unfused section of the spine, or
• wound infection that may require removal of the instrumentation.

The importance of early detection

When scoliosis is detected early:

• curve progression can be closely watched by your family doctor or orthopedic specialist
• treatment, if required, can be started immediately
• successful bracing may eliminate the need for surgery
• if surgery is required it can be undertaken before severe progression occurs.

What can my family do to ensure that scoliosis is detected early?

• Have your family doctor examine your children at an early age for scoliosis.
• Every few months during early the early teen years, examine your child in the forward-bend position.
• Talk to other families about having their children checked for scoliosis.

If you wish to learn more about scoliosis, ask your family doctor or contact a local Scoliosis Resource Group.