Witten by: Dr. Trevor Wahlquist
June is National Scoliosis Awareness Month and a great opportunity to review the signs and symptoms that may be present and allow for an early diagnosis. Setting aside this month allows for better patient advocacy, positive awareness, and education for patients, their families, and physicians in the early diagnosis and treatment of this condition.
Scoliosis is a fairly common condition of the spine where there is an abnormal curvature of the bones. The spine runs from the base of the skull all the way down to the pelvis and can be broken down into three sections: cervical, thoracic, and lumbar. When you view it from the front, it should be straight up and down. However, in the condition of scoliosis, this can form an S or C shaped curve and also has a resulting twist of the spine.
There are number of different causes of scoliosis. The most common (roughly 80% of all scoliosis) is idiopathic, meaning it occurs for no particular reason. This is the type most commonly thought of and is oftentimes seen in young females. However, both males and females can be affected. This condition can also run in families. Adolescent idiopathic scoliosis is seen in roughly 3% of the population primarily between the ages of 10 and 15. It occurs in the female population at a rate eight times that of males. It also occurs earlier in females than males primarily around growth spurts.
Other causes of scoliosis include congenital scoliosis, which occurs when one of the bones is malformed from birth and thus develops at a much younger age typically. Scoliosis can also develop from neuromuscular disorders. These would include disorders such as cerebral palsy, a spinal cord injury, or muscular dystrophy.
Typically, idiopathic scoliosis presents as a visual diagnosis. Oftentimes an individual is identified during an school screening, well-child exams, or by observations by a parent. Most children are asymptomatic (meaning they have no pain or physical dysfunction). Thankfully, most cases are extremely mild and require only annual observation. Roughly 1 in 6 patients diagnosed with scoliosis will need some sort of care beyond observation alone. In these cases, the curve can progress to the point of needing brace stabilization. The intention behind bracing is to prevent the progression of the spinal curve. This will not be corrected by bracing but can get the patient through skeletal maturity and hopefully prevent the need for surgery. Bracing has specific indications based on the severity of the curve via x-rays. The effectiveness of bracing is directly related to how compliant the patient is in wearing their brace. Surgery can sometimes be indicated if a patient has failed non-operative treatment or the curve has already progressed past the point of what a brace can do. This more severe case of scoliosis is typically much more noticeable and can even result in breathing difficulties or heart issues due to the organs being compressed. Surgical correction can be quite effective and alleviating these symptoms as well as improving posture and giving patients more physical confidence.
Early evaluation of scoliosis can be helpful to prevent progression and help patients live more active and healthy lifestyles. There are a number of different signs to pay attention to in your child.
-a visible curve of the spine (oftentimes noticed when in a swimming suit).
-uneven height of shoulders
-having a more prominent shoulder blade on one side compared to the other
-uneven waistline (one hip is elevated compared to the other)
-when bending forward, one side of the back is more prominent
Currently, nationwide screening has been discontinued in the schools after the U.S. Preventative Services Task Force deemed this unnecessary in 1996. In 2008, a collaboration of the American Academy of Orthopedic Surgeons, Scoliosis Research Society, Pediatric Orthopedic Society, and the American Academy of Pediatrics issued a statement that they would not support this recommendation. Fortunately, many states have continued individually, and it is worth calling your school to see if they are participating.
Parents should make sure scoliosis screening is part of an annual well child check from roughly the ages of 10-14. A simple screening of shoulder height assessment, waist height assessment, and a forward bend test looking for a prominent side is sufficient to catch most cases. Scoliosis evaluations in infant and young child exams can also be important, especially if any neuromuscular disorders. The heart and kidney develop at the same time as the spine in utero, so if any concerns are identified with these organs, further scoliosis evaluation is warranted and a younger age. If any tests are positive, an x-ray of the spine would then be warranted. If this is greater than 10 degrees, further evaluation with a Pediatric Orthopedic surgeon would be appropriate.