Scoliosis is a disorder in which the normally straight vertical line of the spine curves to one side. According to the National Scoliosis Foundation, it affects 2 to 3 percent of the population, or an estimated 6 to 9 million people. While it is found in people of all ages, scoliosis most often develops in children between the ages of 10 and 15. Most types of scoliosis are more common in girls than in boys. When a boy develops scoliosis an MRI of the spine is recommended. “The signs of scoliosis are often detected by parents or in school screenings,” says Dr. Fabien Bitan, orthopedic spinal surgeon at the Atlantic Spine Center. “A definitive diagnosis is then made by a doctor who will determine the degree of the curve and whether treatment is called for. Parents should be alert to the signs in their children.”
What causes scoliosis?
Birth defects and several other conditions account for only a small percentage of cases. The most common type, found in 80-85% of cases, is idiopathic scoliosis, meaning there is no known cause. However, scoliosis does run in families. About 30% of adolescents who develop it have a family history of the disorder.
Can scoliosis be prevented?
There is currently no reliable evidence that scoliosis can be prevented. Poor posture and sports activities do not cause scoliosis. And while there has been a great deal of debate about heavy backpacks, which are clearly not good for posture or overall spine health, there is no evidence that they cause scoliosis. “Important advice for parents is that they should not feel guilty about a child's scoliosis,” says Dr. Bitan. “Even if a parent has the disorder, which raises the risk for their children, there is nothing they can do to prevent its development.”
What are the signs and symptoms of scoliosis?
Scoliosis sometimes seems to appear almost overnight. Parents may be shocked and feel guilty that they hadn't noticed it earlier but there are several reasons for this. The change in the curve of the spine happens very gradually and is hard to detect until adolescence when a child enters a growth spurt and the curvature becomes more severe. This is also an age at which a child becomes more modest and self-conscious about her body and parents may have fewer opportunities to observe changes. The signs of scoliosis include:
- One shoulder or shoulder blade is higher or more prominent than the other
- One hip is higher than the other
- The head appears to be off-center
- When the child bends forward, one side of the back is higher than the other
Will the spine return to normal on its own?
A curved spine will not straighten on its own, however many children have very slight curves that do not require treatment. The degree to which scoliosis will progress is closely tied to a child's growth. If the spine is almost fully grown, scoliosis will probably not progress much further. If the child is still growing, the curve is likely to worsen and treatment may be needed to prevent further progression.
How is scoliosis treated?
Treatment for idiopathic scoliosis is based on the patient's age, how much more he or she is likely to grow, and the degree of the curve.
- Observation and repeated examination are generally advised for patients with a small curve, under 25 degrees. For those who are still growing, examination every four to six months will determine if the curve is getting larger.
- Bracing may be recommended to prevent a curve from getting worse in those who are still growing and whose curve is moderate, between 25 and 40 degrees. There are different types of braces used for scoliosis, some worn all the time, some only at night. The brace doesn't correct the curve but can prevent it from getting worse. If the curve stays below 40 degrees until the patient stops growing, it will stop its rapid progression but will usually continue to progress slowly at the rate of 1 degree a year throughout life.
- Surgery is used to correct the curve and stabilize the spine when the curve is severe (more than 40-50 degrees), its progression has not been halted by bracing, and the patient is still growing. Surgery generally involves spinal fusion – fusing two or more vertebrae and holding them in place with a metal rod or other device.
Alternative treatments for scoliosis such as physical therapy, electrical stimulation, or chiropractic care have not been found effective in reversing or stabilizing scoliosis.
“Following a diagnosis of scoliosis, parents and their child should take the initiative, learn as much as they can about the condition, and consult a highly qualified, specialist in scoliosis care,” says Dr. Bitan. “A child undergoing treatment for scoliosis needs emotional support and encouragement. In most cases, recovery is complete and children go on to engage in normal activities.”