The Adolescent with Scoliosis (Spinal Curvature)

The month of May in Northeast Cobb means that good weather and pools will be opening soon. Teenagers will be sporting bathing suits and I will be noticing spinal curvatures at poolside. Adolescent Idiopathic Scoliosis (spinal curvature of unknown origin) is the most common form of scoliosis in children.  It occurs in about 3 to 5 children per 1000, who range in age from 10 to 18. Girls are more prone to have it than boys and it runs in families.

            There are 3 types of scoliosis:

1. Early onset or infantile Scoliosis- It occurs in children less than 3 years of age. It is more common in boys and the curvature is more prone to be on the left side of the back. Studies have shown that children with parents of direct European descent have higher rates of this form of scoliosis. This type has a high rate of self resolution. Many of these children are diagnosed due to other health issues.
2. Juvenile Idiopathic Scoliosis- it is less common than the other 2 types and the age range is 4- 10 years old. The curvature is usually on the right and it occurs more in females. This form has a high rate of progressive curvature problems, which means it worsens over time. Many of these children with JVS are candidates for back braces and surgery.
3. Adolescent Idiopathic Scoliosis – It is the most common form of spinal curvature with most children having no significant health history of medical problems. Idiopathic means without known cause. Most of these children are diagnosed by school health screenings and well child checks. The majority are girls. Small spinal curvatures have a lower risk of becoming worse (about 2%) than larger curvatures in younger adolescents (about 70 %) becoming worse.

I would like to focus on the adolescent idiopathic type since it affects more children. 

The treatment for AIS takes into account many factor such as: curve magnitude, age of the child in relationship to their growth pattern, maturity and angle progression. The 3 treatment options are better known as the 3 O’s.

1. Observation
2. Orthosis
3. Operative Intervention

Observation generally occurs in children with curves less than 25 degree angles. Follow up x-rays at regular intervals will occur usually 3-4 months at a time. Observation can occur in patients with 50 degree curvatures if the patient has matured physically.

Orthotics (bracing and casting) range from 25–40 degree possibly 40-50 degree curves. The goal is to prevent further progression of the curvature. Please note that bracing can occur with smaller curves that rapidly have progressed to the 20-25 degree angle or a large curvature in a smaller child, in order, to take advantage of his/her growth spurt.       

Operational intervention (surgery) is for the child with 40 degree or greater curve(s).The goal is to obtain curve correction and prevent curve progression. There is always exception to the 3 O’s.

Studies have shown that Yoga, chiropractics and physical therapy can help strengthen core muscles in the child with AIS but these activities cannot prevent or prevent further curve progression. It was once thought that abdominal and back muscle weakness was a contributing factor in scoliosis. Researchers are still looking into multifactor reasons for developing AIS. The genetic research is the current hot topic for research development. There is no known cause for AIS.

Signs and symptoms to look for include:

1. One shoulder appears higher than the other.
2. The upper back is shifted from the waistline.
3. When the child is bent over touching his/her toes, one shoulder blade may appear higher than the other blade.
4. The hips may appear uneven.
5. A leg may appear shorter that the other leg.

Pain is not usually present. Lower back pain in children is usually caused by physical activity. Core abdominal muscle and back strength may not be fully developed causing pain unrelated to scoliosis.

Use your well child check ups and school screenings to discuss spinal curvature. If you have an immediate member of your family with scoliosis, tell your health care provider. Anticipation and prevention are your best form of defense in battle of scoliosis. See you at the pool.