Scoliosis in Children: Early Detection and Treatment Options
Growth in children may not always go as expected, however, knowing the possible abnormalities and identifying them at the right time can be helpful in effective management and a better quality of life.
What is Scoliosis?
Scoliosis is an abnormality of the backbone. If you look at the backbone from behind, then in normal individuals it is straight. However, in scoliosis, the backbone has a side (lateral) curvature. This curvature can make the spine S or C-shaped. Thus, in scoliosis, the child may appear to be leaning on one side.
Scoliosis is most commonly diagnosed in children and adolescents, particularly during growth spurts. Early detection is crucial in managing this condition effectively and helps prevent complications that may arise as the child grows.
Though scoliosis can affect any part of the spine, the thoracic or upper part of the spine is more affected in children.
What causes Scoliosis in children?
Scoliosis can be classified into different types based on its cause:
Idiopathic Scoliosis – This is the most common type and occurs without an identifiable cause. This type of scoliosis can run in families. There may be instances when no one in the family has been diagnosed with scoliosis before, but that could be due to mild scoliosis that went unnoticed. At times the child presenting with scoliosis may be the first to be diagnosed with identifiable scoliosis.
Congenital Scoliosis –This is scoliosis present since birth, and is caused by abnormal development of the vertebrae while the fetus is still in the womb.
Neuromuscular Scoliosis – The spine is supported by nerves and muscles. An abnormality in these muscles and nerves leads to scoliosis. This type is associated with conditions such as cerebral palsy, muscular dystrophy, or spina bifida.
Apart from the above causes, tumors, infections, or injury of the spine can also lead to the development of scoliosis.
Scoliosis can further be classified as infantile, juvenile, or adolescent scoliosis depending on the time when it was diagnosed. Infantile scoliosis is diagnosed in children younger than 3 years, juvenile in 4-10 years, and adolescent if diagnosed from ages 11-18.
What are the Early Signs and Symptoms of Scoliosis?
Parents and caregivers should watch for early signs of scoliosis in order to identify this condition early. The signs and symptoms may vary in each child and include:
- Uneven shoulders or hips
- Noticeable shoulder blades that project out
- A visible curve in the spine
- One shoulder blade appears more prominent than the other
- Uneven waistline
- The child appears to be leaning to one side
- Changes in the appearance of the skin on the back (discolouration, dimples, etc)
Apart from these symptoms that are noticed the child may have:
- Back pain
- Difficulty standing straight
- Weakness of muscles
- Leg pain
In case one notices any of the above signs or symptoms a consultation with a pediatric orthopedic surgeon must be sought who can accurately identify this condition.
Though scoliosis can affect both genders, it’s women who are more likely to develop this condition.
Importance of Early Detection
Early diagnosis allows for timely intervention, reducing the likelihood of progression to severe curvature, which can impact lung function and overall posture.
If the diagnosis can be made before the child has a growth spurt, then the pediatric orthopedic surgeon can plan for an effective treatment that can prevent the development of a larger deformity/curve.
Apart from specific consultations in case of noticing the problem, pediatric checkups and school health screenings play a vital role in identifying scoliosis at an early stage. Parents should take an active part in their child’s health and ensure they visit a pediatrician for general health checks.
What if Scoliosis remains undiagnosed?
Undiagnosed scoliosis can lead to unwanted complications including:
- Severe Pain
- Physical deformity
- Organ and nerve damage
- Difficulty in breathing
- Spinal fluid leakage
The inability to breathe is a medical emergency.
How is Scoliosis diagnosed? What tests can a parent expect?
Physical Examination – A detailed physical examination is a crucial part of initial screening. The healthcare provider tests for spinal curvature by guiding the child to perform various movements as forward bend. The nerves and muscles are also checked by testing reflexes and muscle strength.
Detailed history- Family history and details of symptoms are also asked during the initial visit. Parents are expected to list out detailed symptoms which include symptoms of the spine and any other problems since they can be associated with scoliosis.
X-rays – Provide a clear image of the spinal curvature and measure its severity.
MRI or CT Scan – These are used in specific cases to assess underlying causes.
Depending on the curvature of the spine, which is measured in degrees scoliosis in children can be mild, moderate, or severe.
Treatment Options for Scoliosis in Children
A very small number of children with scoliosis require treatment, especially if it is diagnosed early. Treatment for scoliosis depends on the severity of the spinal curvature and the child’s age and doesn’t necessarily involve straightening the spine. The larger aim of treating scoliosis is decreasing the symptoms and reducing the spinal curvature. In some cases, surgical intervention may also be required. Below are a few approaches:
Observation and Monitoring
For mild cases, regular monitoring with X-rays is recommended to track the progression of scoliosis. Your doctor may schedule you on a six-monthly visit to check the progression. Over-the-counter medication may be recommended, and physical therapy may be prescribed to strengthen the muscles and improve flexibility.
Bracing
Bracing is used for moderate scoliosis and helps in preventing further progression. The common types of braces include the Boston brace and the Milwaukee brace. One may be prescribed to wear braces for a long period; following the duration is recommended for effective treatment.
Physical Therapy
Specific exercises can help improve posture, strengthen muscles, and support spinal alignment. Daily stretching, core strengthening, and flexibility exercises can be beneficial and should be performed under guidance.
One may also be guided on the posture and recommended activities like swimming for overall improvement.
Surgical Intervention
While the above other methods come under conservative therapy, surgical intervention is the more aggressive approach and may be needed in some cases. In severe scoliosis or rapidly progressing cases your pediatric orthopedic surgeon may recommend the surgical treatment option. Surgery can help in stablising the spine and in decompressing the nerves, if affected due to scoliosis.
Advances in surgical techniques and computer-assisted technology have made the surgical approach less invasive with the advantage of faster recovery time.
Spinal fusion surgery is the most common procedure for scoliosis. The growing rod technique is yet another type, used in younger children to allow continued growth while managing the curvature.
Living with Scoliosis
With proper management, most children with scoliosis can lead active and healthy lives. Regular follow-ups, adherence to treatment plans, and maintaining an active lifestyle are essential in managing the condition effectively.
Scoliosis in children requires timely diagnosis and appropriate intervention to prevent long-term complications. Parents should remain vigilant for early signs and seek medical advice promptly. With advancements in treatment options, children with scoliosis can achieve optimal spinal health and improved quality of life.
References
https://my.clevelandclinic.org/health/diseases/15837-scoliosis
https://www.stlouischildrens.org/conditions-treatments/scoliosis
FAQs for Scoliosis in Children: Signs, Symptoms, Causes, Diagnosis and Treatment Options
Scoliosis can be idiopathic (no identifiable), congenital (present at birth due to vertebral abnormalities), or neuromuscular (associated with conditions like cerebral palsy or muscular dystrophy).
Parents should look for signs like uneven shoulders or hips, a visible curve in the spine, one shoulder blade sticking out more than the other, or the child leaning to one side.
Scoliosis is most commonly diagnosed between ages 10 and 15, during rapid growth spurts. However, it can also be detected in infants and young children.
Mild scoliosis often does not cause pain, but in some cases, children may experience back pain, muscle weakness, or discomfort, especially as they grow.
Yes, scoliosis can worsen as the child grows, especially during puberty. Early detection and treatment can help prevent severe spinal curvature.
Diagnosis involves a physical examination, including the forward bend test, X-rays to measure the spinal curvature, and, in some cases, MRI or CT scans.
Treatment depends on severity and includes observation, bracing, physical therapy, and, in severe cases, surgery such as spinal fusion or growing rod implantation.
Most children with mild scoliosis do not require surgery. Surgical intervention is considered for severe and rapidly progressing cases.
Since most cases are idiopathic, there is no known way to prevent scoliosis. However, early detection through regular check-ups can help manage the condition effectively.
Yes, most children with scoliosis can engage in sports and physical activities. Exercises like swimming and core-strengthening routines can be beneficial. However, high-impact activities should be discussed with a doctor.
Author: Dr. Sujith Omkaram
Consultant Pediatric Orthopedician