Scoliosis

Scoliosis is a spinal defect which causes lateral curving of the spine. The curving usually occurs in childhood during the growth spurt. It can occur without a known cause or may be associated with cerebral palsy and muscular dystrophy. Most cases are mild, however some cases get worse as your child continues to grow. Severe scoliosis can cause breathing difficulties.

Continuous monitoring with X-rays can evaluate worsening of the condition.

No treatment is required in most cases but wearing a brace can stop worsening of the curve. In a few cases, surgery may be required to prevent worsening of scoliosis or to straighten the severely bent spine.

The signs and symptoms off scoliosis include:

• Uneven shoulders: One shoulder is higher than the other,
• Prominent ribs,
• Uneven waist: A side of hip looks higher than the other,
• Severe scoliosis can cause twisting of spine and a standing child appears like the letter “S”,
• Breathing problems and back pain.

When to see a doctor? 

Visit your doctor if your child exhibits any signs and symptoms of scoliosis. Mild curvature develops slowly and causes no pain often making the condition unnoticeable.

The exact cause of scoliosis has not been identified yet. However, it may be caused due to some genetic factors. Scoliosis, less commonly, may be caused by:

• Conditions that affect muscle and nerve coordination, such as, cerebral palsy or muscular dystrophy,
• Injury to spine,
• Infection.

If your child’s signs indicate scoliosis visit your doctor immediately to receive a diagnosis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down key medical information. 

Inform your doctor about family history of scoliosis or other medical conditions. 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• When did your child's problem become noticeable?
• Does your child experience pain or breathing difficulties?
• Does your child have a family history of similar condition?
• Has your child grown rapidly during past six month?

Your doctor will begin the diagnosis by assessing your child’s medical history. To check uneven shoulders or waist, s/he can ask your child to stand and bend forward from the waist, with arms hanging loosely. Some of tests performed by the doctor include:

• Neurological examination: It is performed to determine if your child has weakened muscles, sensation of numbness and abnormal reflexes.

• Imaging Test: X-rays can confirm the diagnosis and determine its severity. To eliminate other possible causes like a tumor, your doctor may also perform additional imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans. CT scans when combined with X-rays produce more detailed image than X-rays alone. 

• Bone scan: In a bone scan, a radioactive material is injected into your child and its movement is recorded as it travels to injured or healing bones.

Mild cases of scoliosis do not usually require treatment but a routine doctor visit every 4 to 6 months can detect changes in spinal curvature. Treatment is determined by:

• Sex: Disease progresses more rapidly in girls.
• Severity of curve
• Pattern of the curve: C-shaped curves has slow progression compared to S-shaped curve or double curves.
• Location of the curve: Curvatures that affect central region of spine worsens faster than the curvatures in upper or lower region of spine.
• Maturity: Rapid worsening is seen during period of  bone growth.

The treatment options include:

Braces

Braces are more effective when used during bone growth in a child. Braces do not actually cure a scoliosis or reverse a curve rather they prevent the curve from worsening. Longer your child wears a brace, greater is its effectiveness. Children with braces can participate in most activities but may have a few restrictions. If required, the braces may be taken off to participate in sports or other physical activities. Braces are discontinued once bone growth stops. This occurs:

• About two years after girls start to menstruate
• When boys need to shave daily
• When no changes in height occurs

The two types of braces are underarm or low-profile brace and Milwaukee brace.

• Underarm or low-profile brace: It is also called thoracolumbosacral orthosis and made of plastic material. It fits under the arms, around the rib cage, lower back and hips and is almost invisible under the clothes. These braces aren’t useful for upper spine curvature.

• Milwaukee brace: This brace occupies the trunk and has neck ring with rests for the chin and back of the head. The brace has flat bar in the front while two flat bars are present in the back. Since they are difficult to use, Milwaukee braces are worn where an underarm brace can't be used. 

Surgery

The severity of spinal curvature may be reduced surgery. The most common type of surgery, called spinal fusion, involves connection of two or more bones in spine by use of piece of bone or bone-like material. The bones then can’t move independently. Metal rods, hooks, screws or wires may be used to keep the spine straight while old and the new bone material are fused together. Surgery is usually done after the bones have stopped growing. If scoliosis worsens at young age, a rod can be installed that can adjust in length as child grows. The rod is attached to the top and bottom section of the spinal curve and lengthened every six months. Bleeding, infection, pain or nerve damage are often the complications of spinal surgery. The bone seldom fails to heal which may require another surgery.

Alternative remedies such as chiropractic manipulation, electrical stimulation of muscles and biofeedback are not effective in healing scoliosis.

Lifestyle modifications are necessary in order to cope with scoliosis.

General exercise or participation in sports may improve overall health and well-being. However, physical therapy exercises are unable to prevent the progression of scoliosis.

A supportive group may be helpful for your child to cope up with the anger, insecurity and fear. It may influence the child's acceptance of scoliosis and its treatment.

There are several risks and complications associated with scoliosis.

Risks

• Age: Children between the age of 9 and 15 are more likely to develop scoliosis.

• Sex: Girls are at higher risk of curvature worsening and more likely to require treatment.

• Family History: A child, with family history of scoliosis, may develop the disease.

Complications

• Lung and heart damage: The rib cage, in severe scoliosis, may compress the lungs and heart thereby making it difficult to breathe and pump the blood.

• Back problem: Children with scoliosis can have chronic back pain later in their life.

• Appearance: Unleveled shoulders, prominent ribs, uneven hips and shifting of waist and trunk to side may occur.