Scoliosis in Children and Adolescents

How Is Scoliosis Diagnosed?

While bending forward trying to touch the floor, the levels of the shoulder blades (thoracic) and lower back (lumbar) are compared using a handheld device called a scoliometer. Any difference measured between the left and right sides of the back is called scoliosis.

Most spine curves in children with scoliosis will remain small and need only to be watched for any sign of progression. Observation only is appropriate if the angle of the curve is not severe (less than 20 degrees) or if the child is near skeletal maturity (finished growing). Small curves can increase with rapid growth and will require re-examination every 6 months. Most cases of scoliosis referred through school screening will fall into this small curve category.

Long-Term Effects If Scolosis Is Not Treated

If left untreated, scoliosis can have some long-term effects. Depending on the degree of curvature, the condition can worsen during adult life. The spine may buckle under the added load and the curve will become worse. In addition to curving, the spine can begin to rotate, contributing to diminished lung capacity and the development of restrictive lung disease. Cosmetic concerns are significant to many patients. The incidence of back pain among patients with scoliosis approximates that of the general population.

When Is Treatment Necessary?

A positive history of scoliosis in the family, the age at which the curve began, the curve's location and severity of the curve are important factors that help determine treatment.

The treatment of patients with idiopathic scoliosis begins with an estimation of the probability for curve progression. The two major determinants of curve progression are the patient's age (both chronological and bone development) and the size of the curve.

Small curves measuring less than 20-25 degrees that do not require brace treatment should be observed during periodic examinations of four to six months or 1 year intervals based on their size. Observation is important because any 5 degree increase in the size of the curve may change the course of treatment.

In general, the current treatment of adolescent idiopathic scoliosis is guided by certain principles. First, small curves in older patients have less chance of progression than larger curves in younger patients. Second, adolescent curves greater than 40 degrees are difficult to control mechanically with braces. Third, adult curves greater than 50 degrees will continue to progress at an average rate of 1 degree per year. Taken together, the goal of treatment is to keep adolescent curves less than 50 degrees. Finally, cosmetic considerations should only be a rare, primary indication for surgery. The following are guidelines for adolescents who are skeletally immature (child’s bones are still growing).

Other Treatments

Surface electrical stimulation has been discredited as a treatment, and studies have shown that the children treated in this way do no better than those left untreated. Treatment such as manipulation has no place in the management of the mechanical defect in scoliosis, although manipulation and physical therapies can help any low back pain that occurs in association with a scoliosis.

Exercises can be prescribed, but they will probably not effect the progression of a curve. If a brace is required, an exercise program will also be prescribed. If a brace is not required, instruction regarding review of the scoliosis and exercises should be provided.

Kids and Backpacks

Backpacks do not cause scoliosis. The extra stress placed on the spine and shoulder from the heavy loads that children carry in their backpacks can cause back muscle fatigue and strain. Excessive weight in backpacks could cause some children to develop bad habits early in life like poor posture or excessive slouching. The following suggestions may help lessen back pain:

• Use a hip strap for heavier weights.
• Use a backpack with padded, wide straps and a padded back.
• Use both of the backpack's straps, firmly tightened, to hold the pack two inches above your waist.
• Engage in exercises to condition your back muscles.
• Use the correct lifting techniques. Remember, bend with both knees when picking up a heavy backpack.
• Place the heaviest items close to your back.
• Neatly pack your backpack, and try to keep items in place.
• Try to make frequent trips to your locker, between classes, to replace books.
• Consider purchasing a backpack with wheels.

Summary

Scoliosis is a common problem that usually requires only observation with repeated examination in the growing years. Early detection is important to make sure the curve does not progress. In the relatively small number of cases that need medical intervention, advances in modern orthopedic techniques have made scoliosis a highly manageable condition.