Check Your Child For Signs Of Scoliosis

Officially, June was National Scoliosis Awareness Month, as declared by the United States Congress and supported by the Scoliosis Research Society.  Such a declaration is a great way to bring attention to a condition that affects thousands of people in the United States and around the world.  But, because of its prevalence and because of how important early diagnosis and intervention are, I think every month should be scoliosis awareness month.

What is Scoliosis?

In short, scoliosis refers to an atypical side-to-side curvature of the spine.  The typical human spine does have a natural curvature.  The natural curve of the spine rounds our shoulders and curves our lower backs slightly inward.  By contrast, the spines of people with scoliosis curve side-to-side and rotate.  A normal spine is straight, from top to bottom and does not rotate.  The spine of a person with scoliosis is either “S” shaped or “C” shaped and adversely affects his or her posture.  Someone with scoliosis can look as though their shoulders or waist are uneven and sometimes, because of the rotation of the spine, one shoulder blade can be more prominent.

Get local news delivered in your email daily. It's like getting a free newspaper.

A straight, strong spine is important to everyone’s overall health and well-being.  In addition to creating some physical limitations, severe scoliosis can adversely affect people’s heart and lung development and functions, among other complications.

Scoliosis is a common condition that is generally found more often in females.  There are three categories of scoliosis:

• Congenital -- meaning a child is born with a spine deformity.  The deformity is caused by vertebrae that are not properly formed and likely happens very early in a pregnancy, usually within the first six weeks.  The actual cause is not known and it is not believed to be hereditary.  Scoliosis can be detected in the infant or toddler years, but sometimes is not detected until adolescence.
• Neuromuscular -- meaning scoliosis is a result of a neurologic disorder such as cerebral palsy or muscular dystrophy, among others.  The spinal curvature is progressive and can continue into adulthood.  Non-surgical treatment, such as bracing, may temporarily control a neuromuscular spinal deformity, and provide improved sitting balance but cannot control a neuromuscular scoliosis indefinitely.
• Idiopathic -- meaning no specific cause for the scoliosis is known.  More than 80% of scoliosis cases are idiopathic.  It is especially common in adolescent (aged 11-18) girls.

How Do I Know if My Child Has Scoliosis?

Early detection of scoliosis is very important, as early intervention, when necessary, will produce better outcomes.  Pediatricians and parents both play key roles in detecting whether a child has scoliosis.

Pediatricians have the primary responsibility of screening children for scoliosis.  During your child’s annual check-up, the pediatrician should conduct a visual inspection of his or her spine in the standing and forward bending positions.  If the pediatrician has any concerns about your child’s spine health, he or she will discuss it with you and form a plan of action that may include additional testing, like x-rays, and referral to a pediatric orthopedic specialist.

Parents can play an important role too.  While generally observing your children, you will sometimes be able to detect signs of scoliosis – look to see if the spine doesn’t seem to be straight in a standing or forward bending position, if the shoulders are uneven, or if you notice waistline differences.  These findings are different from “poor posture” or slouching, and, if identified, require explanation.  Parents can conduct the “Adam’s Forward Bending Test,” on their own children. It’s easy and simple to do, and can help the parent identify an abnormality in their child’s spinal shape, leading to early detection and treatment. 

This Forward Bending test is very simple to perform:

• Have your child wear a top that allows you to see the majority of his or her back.
• Sit behind him or her on a chair
• Ask him or her to bend forward at the waist with knees straight, arms hanging loosely, and palms touching.
• Looking from behind, the spine should be level comparing left to right sides.
• Observe whether the spine seems to be straight; the boney spines of each vertebra should be in a straight line
• If there is any asymmetry or unevenness in the back or ribs, a scoliosis may be present.
• If you scoot around to the side of your child, you can evaluate the spine shape in the forward leaning position and determine if it looks smooth like a hill, or is peaked like a mountain. A sharp peak may suggest another spinal problem known as “kyphosis.”

If you observe what may be some signs of scoliosis or kyphosis, the next step is to bring your child to the pediatrician.  The pediatrician will repeat the forward-bending test and may use a device called a scoliometer to measure the rotation of the spinal curve.  As I mentioned earlier in this post, if your pediatrician detects scoliosis in your child, he or she will work with you to determine next steps.

Treating Scoliosis

A good treatment plan for scoliosis should be tailored to the individual and his or her specific conditions.  Many things are factored into the treatment plan including the type of scoliosis, the degree and nature of the curvature and the age of the person when diagnosed. Not all treatment options are appropriate or effective for all patients.  And, importantly, many cases of scoliosis require no intervention at all. Your physician may recommend a long spinal radiograph be done on your child, in the standing position, to further evaluate his or her spine.  This is known as a scoliosis x-ray and it provides the basic information that a physician needs to determine the type and severity of scoliosis, detect the presence of a kyphosis or other sagittal (side view) spine problems and provides an estimate of your child’s skeletal maturity. Scoliosis x-rays should be used sparingly to minimize radiation exposure. New methods of assessing scoliosis that do not use x-ray are being developed, and should help decrease the need for x-rays in scoliosis management.

Usually, when a small curve (less than 20 degrees) is detected in a growing child, a structured program of observation is initiated.  Curves are more likely to progress in rapidly growing children. For this reason, the child’s spine is examined at four to six month intervals, looking for any adverse changes. The patient’s growth curve is checked at each visit. Once a child has stopped growing, the risk of further curve progression decreases significantly.  If the curve does not progress, observation continues until growth ceases, and often no further treatment is required as small scoliosis curves remains stable over time, and offer no long term health risks.

In a growing child, if the scoliosis is more than 25 degrees on the first visit, or if scoliosis progression is documented, a brace is often prescribed.  Bracing is the only treatment that has been proven to control scoliosis progression for idiopathic scoliosis. An interesting note -- braces are often named after the cities they were developed in. For instance, the Boston Brace,  Providence Brace  and Lyon Brace hail from cities of the same name in Massachusetts, Rhode Island and France, respectively.   A typical scoliosis brace program requires a minimum of 16 hours per day of wearing time and usually lasts for about two years. The duration of bracing is dictated by the patient’s growth and he or she is weaned out of the brace once spinal growth stops. The brace functions by correcting the curve and harnessing the remaining spinal growth to correct or stabilize the scoliosis, much like staking a crooked tomato plant!

Braces are not always appropriate. They cannot control congenital deformities or patients with severe scoliosis, usually more than 50 degrees. Certain children cannot tolerate bracing for a variety of reasons and some simply refuse to wear a brace. Some curves cannot be controlled, in spite of our best efforts. In these cases other interventions, including surgery, are explored for cases when bracing is not effective or is unlikely to produce the best results.

While other alternative treatments for scoliosis have been attempted, including physiotherapy/exercise, electrical stimulation, chiropractic treatments, acupuncture, and various medical potions, none have been proven effective. Only bracing has demonstrated proven effectiveness in controlling scoliosis progression.

A Final Word

Scoliosis is a common cause for spinal mal-alignment. Luckily, it usually is not life threatening, but can have serious consequences if left untreated.  It is important to detect it as early as possible, monitor closely for curve progression and initiate brace treatment when indicated. As a parent, you can keep an eye out for early signs of scoliosis by doing the visual inspection of your child’s back once per year, during their peak growth years, usually ages 10-14.  And, most importantly, be sure your pediatrician is monitoring your child’s spine health.  If you don’t remember or aren’t sure if your children’s doctor checked their spines at previous visits, be sure to ask about it at your next visit.

For more information about scoliosis please log on to the Scoliosis Research Society Website, www.SRS.org or iscoliosis.com

Steven Mardjetko, MD, is a Pediatric Spinal Deformity Surgeon and Pediatric Orthopedic Specialist at Advocate Lutheran General Hospital.