02 July 2009

Curvature of the spine: Could your child have scoliosis?

In a person with scoliosis, the spine may curve side-to-side in a "C" or "S" shape. Sometimes the spinal bones (vertebrae) may also twist. © iStockphoto.com

By Laurie Sammeth, Contributing Writer, myOptumHealth

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Subtle signs of scoliosis, such as an uneven hemline or one hip appearing higher than the other, may first be noticed during a growth spurt in the early teen or preteen years. While these signs can be alarming, scoliosis is usually mild and won't get worse. Only about four children in 1,000 will need any treatment for it. In some cases, bracing is used to stop the progression of a curve. Rarely, surgery is needed to correct it.

Scoliosis is an abnormal curve of the spine. Normally when you look at a person's back, the spine or backbone falls in a straight line from the base of the neck to the tailbone. In a person with scoliosis, the spine may curve side-to-side in a "C" or "S" shape. Sometimes the spinal bones (vertebrae) may also twist.

What causes scoliosis?

Most of the time, doctors don't know what causes scoliosis. In these cases, it is called idiopathic scoliosis. In a few cases, it may be caused by another condition, such as a connective tissue or neuromuscular disorder.

Scoliosis tends to run in families. Idiopathic scoliosis occurs more often and tends to progress more in girls than in boys. Posture, a heavy book bag, or diet and exercise have nothing to do with whether someone will develop scoliosis.

What are the symptoms?

Scoliosis usually causes the spine to curve in an "S" or "C" shape. There may be no symptoms in the early stages of mild scoliosis. Signs of scoliosis include having:

One shoulder higher than the other
An uneven waistline
Ribs that stick out farther on one side of the body
A shoulder blade that sticks out farther on one side of the body
A tendency to lean to one side
Most cases are mild and don't get worse. In other cases, early treatment with a brace may prevent a curve from getting worse.

If scoliosis becomes severe, it may cause back pain or breathing problems. The earlier a child develops it, the more severe the curve can become.

How is it treated?

What treatment your child may need for scoliosis will depend on his age and how much more a child is expected to grow. Treatment also depends on how severe the curve is.

The main treatments for scoliosis include:

Observation. If your child has only a mild form (a spinal curve under 25 degrees), she most likely will not need treatment. But she should see the doctor every four to six months for observation until she stops growing.
Bracing. If your child is still growing and has a spinal curve over 25 to 30 degrees, he may need to wear a brace to prevent the curve from getting worse. There are many different kinds of braces and each must be custom fit for your child.
A brace will not correct the spinal curving but may keep it from getting worse. Your child must wear the brace every day for as long as the doctor recommends. But she can often take it off to exercise and play sports.

Surgery. If your child's scoliosis is severe (a spinal curve over 45 to 50 degrees) or if bracing does not stop its progression, surgery may be suggested. Surgery involves fusing (connecting) two or more vertebrae to straighten the backbone and inserting a permanent implant, such as a metal rod, to help keep it straight.
Having scoliosis can affect your child's self-esteem during the vulnerable teen years. It may be helpful to join a support group of others coping with the same condition.

US Preventive Services Task Force (USPSTF). Screening for idiopathic scoliosis in adolescents.
Scoliosis Association. Scoliosis facts.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Scoliosis.
Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. American Family Physician. 2002;65:1817-1822.
American Academy of Orthopaedic Surgeons. Scoliosis in children and adolescents.

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