Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.
Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly.
Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.
Symptoms and causes
Signs and symptoms of scoliosis may include:
- Uneven shoulders
- One shoulder blade that appears more prominent than the other
- Uneven waist
- One hip higher than the other
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side.
When to see a doctor
Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves, however, can develop without the parent or child knowing it because they appear gradually and usually don't cause pain. Occasionally, teachers, friends and sports teammates are the first to notice a child's scoliosis.
Doctors don't know what causes the most common type of scoliosis — although it appears to involve hereditary factors, because the disorder tends to run in families. Less common types of scoliosis may be caused by:
- Neuromuscular conditions, such as cerebral palsy or muscular dystrophy
- Birth defects affecting the development of the bones of the spine
- Injuries to or infections of the spine
Risk factors for developing the most common type of scoliosis include:
- Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty.
- Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
- Family history. Scoliosis can run in families, but most children with scoliosis don't have a family history of the disease.
While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:
- Lung and heart damage. In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.
- Back problems. Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population.
- Appearance. As scoliosis worsens, it can cause more noticeable changes — including unlevel shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.
The doctor will initially take a detailed medical history and may ask questions about recent growth. During the physical exam, your doctor may have your child stand and then bend forward from the waist, with arms hanging loosely, to see if one side of the rib cage is more prominent than the other.
Your doctor may also perform a neurological exam to check for:
- Muscle weakness
- Abnormal reflexes
Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature. If a doctor suspects that an underlying condition — such as a tumor — is causing the scoliosis, he or she may recommend additional imaging tests, such as an MRI.
Most children with scoliosis have mild curves and probably won't need treatment with a brace or surgery. Children who have mild scoliosis may need checkups every four to six months to see if there have been changes in the curvature of their spines.
While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis.
Factors to be considered include:
- Sex. Girls have a much higher risk of progression than do boys.
- Severity of curve. Larger curves are more likely to worsen with time.
- Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped curves.
- Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections of the spine.
- Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in children whose bones are still growing.
If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents further progression of the curve.
The most common type of brace is made of plastic and is contoured to conform to the body. This close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.
Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.
Braces are discontinued after the bones stop growing. This typically occurs:
- About two years after girls begin to menstruate
- When boys need to shave daily
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to reduce the severity of the spinal curve and to prevent it from getting worse. The most common type of scoliosis surgery is called spinal fusion.
In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
If the scoliosis is progressing rapidly at a young age, surgeons can install a rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal curvature, and is usually lengthened every six months.
Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal and another surgery may be needed.
Studies indicate that the following treatments for scoliosis are ineffective:
- Chiropractic manipulation
- Electrical stimulation of muscles
- Dietary supplements