The Importance of Early Detection of Scoliosis in Children
What is Scoliosis?
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.
Avoiding scoliosis and maintaining good posture are universal concerns among parents today. Many of these parents may be surprised to know that small curves are a normal part of spine anatomy. Julia Hale, Physician Assistant Pediatric Orthopedics, and the Pediatric Orthopedic Surgery Department at Hospital for Special Surgery provides an overview on the importance of early detection of scoliosis in children for National Scoliosis Awareness Month:
1. Scoliosis is usually detected by a pediatrician, school nurse during “school screening” or parent (often times some asymmetry of the rib cage may be noted while a child is in a bathing suit or when trying on clothes). A child with scoliosis may have a protruding scapula or uneven hips, where one leg appears longer.
2. Children with suspected scoliosis should see a chiropractor or pediatric orthopedics who can confirm the diagnosis with physical examination and x-rays. A curve of greater than 10 degrees on x-ray is considered to be scoliosis. At HSS, in children younger than ten years of age, an MRI of the entire spine is recommended. According to Dr. Daniel Green, pediatric orthopedic surgeon, “In some cases, even though the vertebral bones may be healthy, the spinal cord may not be.” MRI images can help the orthopedist detect the presence of other problems such as syrinx—a cyst in the spinal cord, or tethered cord, in which the spinal cord is abnormally attached to the bony spine.
3. Scoliosis is diagnosed as one of three types: idiopathic, of unknown origin; congenital scoliosis, in which the bones are asymmetrical at birth and the vertebrae may be partially formed (hemi-vertebra) or wedge-shaped; and neuromuscular scoliosis, in which the scoliosis is symptomatic of a systemic condition such as cerebral palsy, muscular dystrophy, or paralysis.
4. In all its forms, early diagnosis of scoliosis is a primary goal. Treatment is guided by the specific scoliosis type, the amount of growth the child has left, the degree of the deformity, and anticipated progression of the condition. “Children with infantile and juvenile scoliosis have the greatest risk of curve progression, as well as the greatest risk of developing secondary pulmonary complications from scoliosis,” explains Dr. Roger F. Widmann, Chief of Pediatric Orthopedic Surgery at HSS.
Detection, Diagnosis, and Monitoring
Scoliosis most typically occurs in individuals 10 to 18 years old and is often detected by school screenings or regular physician visits. A medical professional will look for:
- Curvature of the spine
- Uneven shoulders, or protrusion of one shoulder blade
- Asymmetry of the waistline
- One hip higher than the other.
Once scoliosis is detected, a physician will continue to monitor the curvature (read more about scoliosis observation). The progression of spinal curvature is very well understood and is measured in degrees.
- Mild curvature that remains at 20 degrees or less will most likely require monitoring and observation, but further treatment is rarely needed.
- Curvature greater than 20 degrees may require non-surgical or surgical intervention, including treatments such as a back brace for scoliosisor scoliosis surgery, both of which prevent further progression of the curve.
Preventing severe curvature is important for the physical appearance and health of the patient. Curves greater than 50 degrees are more likely to progress in adulthood. If a curve is allowed to progress to 70 to 90 degrees, it will produce a disfiguring deformity.
A high degree of curvature may also put the patient at risk for cardiopulmonary compromise as the curve in the spine rotates the chest and closes down the space available for the lungs and heart.