Scoliosis

Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.

Spinal curvature; Kyphoscoliosis

There are three general causes of scoliosis:

• Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb or early in life.
• Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio.
• Idiopathic scoliosis is scoliosis of unknown cause. Idiopathic scoliosis in adolescents is the most common type.

Some people may be prone to curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.

A doctor may suspect scoliosis if one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers often do not notice the curving in the earlier stages.

Other symptoms can include:

• Backache or low-Back pain
• Fatigue
• Shoulders or hips appear uneven
• Spine curves abnormally to the side (laterally)

There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if there is irritation to the soft tissue and wear and tear of the spine bones.

Note: Kyphoscoliosis also involves abnormal front to back curvature, with a "rounded back" appearance. See: Kyphosis

The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.

Tests may include:

• Scoliometer screening (a device measures the curvature of the spine)
• Spine x-rays(taken from the front and the side)
• MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )

Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months.

As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.

• Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider.
• A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.

The choice of when to have surgery will vary. After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may want to wait until your child's bones stop growing. But your child may need surgery before this if the curve in their spine is severe or is getting worse quickly. Curves of 40 degrees or greater usually require surgery.

Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important.

Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.

See: Scoliosis - support group

The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped.

The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.

Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis can do very well and can lead active, healthy lives.

Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.

• Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
• Failure of the bone to join together (very rare in idiopathic scoliosis)
• Low back Arthritis and pain as an adult
• Respiratory problems from severe curve
• Spinal cord or nerve damage from surgery or severe, uncorrected curve
• Spine infection after surgery

Call your health care provider if you suspect your child may have scoliosis.

Routine scoliosis screening is now done in middle and junior high schools. Because of screening, many cases that would have previously gone undetected until they were more advanced, have been diagnosed at an earlier stage.

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509, vi.

Lonner, B. S. Emerging minimally invasive technologies for the management of scoliosis. Orthop Clin North Am. 2007;38(3): 431-440.

Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a tiny bit. But people with scoliosis have a spine that curves too much. The spine might look like the letter “C” or “S.”

Spinal curvature; Infantile scoliosis; Juvenile scoliosis

Most of the time, the cause of scoliosis is unknown. This is called idiopathic scoliosis. It is the most common type. It is grouped by age.

• In children age 3 and younger, it is called infantile scoliosis.
• In kids age 4 - 10, it is called juvenile scoliosis.
• In older kids age 11 - 18, it is called adolescent scoliosis.

Scoliosis most often affects girls. Some people are just more likely to have curving of the spine. Curving generally gets worse during a growth spurt.

Other types of scoliosis are:

• Congenital scoliosis: This type of scoliosis is present at birth. It occurs when the baby's ribs or spine bones do not form properly.
• Neuromuscular scoliosis: This type is caused by a nervous system problem that affects your muscles, such as cerebral palsy, muscular dystrophy, spina bifida, and polio.

Usually there are no symptoms. But symptoms can include:

• Backache or low-back pain
• Tired feeling in the spine after sitting or standing for a long time
• Uneven hips or shoulders (one shoulder may be higher than the other)
• Spine curves more to one side

Kyphoscoliosis is another type of abnormal curving of the spine. For more information, see: Kyphosis

The health care provider will perform a physical exam. You will be asked to bend forward. This makes your spine easier to see. It may be hard to see changes in the early stages of scoliosis.

The exam may show:

• One shoulder is higher than the other
• The pelvis is tilted

X-rays of the spine are done. It is important to have x-rays, because the actual curving of the spine may be worse than what your doctor can see during an exam.

Other tests may include:

• Spinal curve measurement (scoliometer screening)
• MRI of the spine

Treatment depends on many things:

• The cause of scoliosis
• Where the curve is in your spine
• How big the curve is
• If your body is still growing

Most people with idiopathic scoliosis do not need treatment. However, you should be checked by a doctor about every 6 months.

If you are still growing, your doctor might recommend a back brace. A back brace prevents further curving. There are many different types of braces. What kind you get depends on the size and location of your curve. Your health care provider will pick the best one for you and show you how to use it. Back braces can be adjusted as you grow.

Back braces work best in people over age 10. Braces do not work for those with congenital or neuromuscular scoliosis.

Sometimes, surgery is needed.

• Scoliosis surgery involves correcting the curve as much as possible.
• The spine bones are held in place with one or two metal rods, which are held down with hooks and screws until the bone heals together.
• Surgery may be done with a cut through the back, belly area, or beneath the ribs.

After surgery, you may need to wear a brace for a little while to keep the spine still.

You may need surgery if the spine curve is severe or getting worse very quickly. The surgeon may want to wait until all your bones stop growing, but this isn't always possible.

Scoliosis treatment may also include:

• Emotional support. Some kids, especially teens, may be self-conscious when using a back brace
• Physical therapy and other specialists to help explain the treatments and make sure the brace fits correctly.

See: Scoliosis - support group

How well you do depends on the type, cause, and severity of the curve. The more severe the curving, the more likely it will get worse after you stop growing.

People with mild scoliosis do very well with braces. They usually do not have long-term problems. However, scoliosis can make you more likely to have back pain when you get older.

The outlook for those with neuromuscular or congenital scoliosis varies. Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Congenital scoliosis is difficult to treat and usually requires many surgeries.

Complications of scoliosis can include:

• Breathing problems (in severe scoliosis)
• Low back pain
• Lower self-esteem
• Persistent pain if there is wear and tear of the spine bones
• Spinal infection after surgery
• Spine or nerve damage from an uncorrected curve or spinal surgery

Call your health care provider if you suspect your child may have scoliosis.

Routine scoliosis screening is now done in middle and junior high schools.

Screening has helped detect early scoliosis in many kids.

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38:497-509, vi.

Lonner BS. Emerging minimally invasive technologies for the management of scoliosis. Orthop Clin North Am. 2007;38:431-440.

Review Date: 09/21/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.., and Dennis Ogiela, MD, Orthopedic Surgeon, Danbury Hospital, Danbury, CT. Review provided by VeriMed Healthcare Network.

Remember when you were a kid, and every year you had to line up in front of the school nurse and bend over so she could check your spine? What she was looking for was scoliosis, or a curved spine.

Sometimes babies are born with a curved spine, because bones called vertebrae in their spine didn't form correctly in the womb. Others develop scoliosis because of conditions that weaken the muscles or lead to paralysis, like cerebral palsy, muscular dystrophy, spina bifida, or polio. Sometimes doctors can't find a cause for scoliosis.

So, what are the signs your child has scoliosis?

You might notice that one shoulder is higher than the other, or the pelvis is tilted. If the spine is only a little bit curved, you may not spot any differences in your child's body. But sometimes the abnormal curve can cause backaches.

Your doctor will diagnose scoliosis with the same test school nurses use, by having your child bend over and looking for a curve in the spine. A nervous system exam can find problems with strength or reflexes. Imaging tests such as x-rays or an MRI will give the doctor a better view of your child's spine.

Now, if scoliosis is diagnosed, you probably ask, how is it treated?

Children and teens who don't have much of a curve in their spine may not need to be treated. They should just be checked about once every 6 months to make sure the curve hasn't gotten worse. Kids with more severe scoliosis may need a brace to press the spine straight. Bracing only works for certain types of scoliosis, though.

Really dramatic curves usually need surgery to fuse the bones in the spine together. The bones are held in place with hooks and screws until they heal together.

The biggest impact of scoliosis is usually on a child's appearance. Having a curved spine can be embarrassing, and it can help for kids to get emotional support while they are being treated. When scoliosis is minor enough to be treated with a brace or surgery, kids usually do very well. A more severely curved spine is likely to get worse after the child stops growing. Kids with severe scoliosis may develop breathing problems and low back pain as adults.

Because middle schools screen students for scoliosis, it's caught much earlier than it used to be, offering kids a better chance for treatment. If you think your child might have scoliosis, call your doctor.

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.