Understanding Scoliosis: Early Detection and Treatment in Children
By Faye Pun
Most cases of scoliosis are mild, and can worsen as a child grows. They usually require correction via brace and exercise. Severe cases can impair lung function and may require surgery via spinal fusions to correct.
Assessing Risk
Scoliosis can be easy to miss. What signs can parents look out for?
There are a wide variety of risk factors associated with idiopathic scoliosis, although the root cause is still unknown. Symptoms usually appear in adolescence, with girls having a higher risk of the curve worsening and requiring treatment than boys. Although scoliosis can run in the family, a majority of cases have no prior family history of scoliosis.
Symptoms
It is important to consult your child’s physician if you notice any of these signs in your child.
Uneven shoulders
Uneven waist
Prominence of one shoulder blade
One side of rib cage jutting out
Prominence of one side of the back when bending forward
Diagnosis
During the physical examination, your physician may perform the Adam’s forward bend test to check for prominence of one side of the rib cage. They may also include a neurological examination to check muscle weakness, numbness, and reflexes. After this, an X-Ray can be used to confirm the diagnosis.
Here are some alternative options to reduce radiation exposure from X-Rays while still enabling one to track the progression of scoliosis:
Lower radiation dose imaging. This method can create a detailed 3-D model of the spine. However, it may not be available for all medical centers.
Ultrasound. Ultrasound can be used as a tool for screening and monitoring, though it is less precise in gauging the severity of the curve.
Magnetic resonance imaging (MRI). MRI is recommended if your healthcare provider suspects an underlying condition is causing the scoliosis.
Treatment
Treatment for scoliosis depends largely on the severity of the curve and the age of the patient. A larger curve has a higher risk of worsening. In addition, if a child’s bones are still growing, the risk of progression is higher.
Children with very mild curves do not need any treatment, although regular checkups should be done to check for progression. Children may also benefit from physical therapy (such as Schroth exercises) which includes posture, breathing, strength, functions of daily life, and self image.
In cases of mild scoliosis where the bones are still growing, a brace may be used to prevent progression. Most braces will be worn 13 to 16 hours a day and the child can participate in most activities while wearing it. The brace will stay on until there are no further changes in height.
Severe scoliosis may require surgery to straighten the curve and prevent progression. There are three main types:
Spinal fusion. Surgeons connect a few pieces of vertebrate together and place pieces of bone-like material between the vertebrae. Metal rods, hooks, screws, or wires hold the vertebrae together until the old and new bone material have fused together.
Expanding rod. In younger patients who are progressing rapidly, surgeons can connect one or two expandable rods that are adjusted as the child grows through surgery or through remote control.
Vertebral body tethering. Screws are placed along the outside edge of the spinal curve. A strong, flexible cord is threaded through the screws to straighten the spine.
Conclusion
The earlier we can detect scoliosis, the easier it is to treat. Parents can help catch scoliosis early with regular check ups with a child’s primary healthcare provider and making sure to pay attention to any symptoms.
Works Cited
Flynn, John. “Scoliosis: Early Detection Matters.” CHOP, Children’s Hospital of Philadelphia, 19 Oct. 2020, www.chop.edu/news/health-tip/scoliosis-early-detection-matters. Accessed 18 Aug. 2024.
Mayo Clinic. “Scoliosis - Symptoms and Causes.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 May 2023, www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716. Accessed 18 Aug. 2024.
Stitzel, Clayton. “Strategies for Early Stage Scoliosis Intervention.” ScoliSmart, ScoliSmart, 12 June 2024, treatingscoliosis.com/blog/early-stage-scoliosis-intervention-prevention-strategies/#:~:text=Treatment%20options%20vary%20based%20on. Accessed 18 Aug. 2024.
