Scoliosis Treatment for Children at King’s
What is Scoliosis?
Scoliosis causes the spine to curve sideways. It is different from other spinal curvature conditions, such as kyphosis, where the spine is curved forward resulting in a rounded back and lordosis, where the spine is curved backwards.
Common signs and symptoms of scoliosis
Scoliosis does not cause pain while children are growing and due to this, it can go unnoticed until the condition becomes more obvious and severe. In some cases, parents may notice a difference in the height of the shoulder and pelvis while their child is standing. Females may notice as they get older that their breasts are not symmetrical or that their bra does not fit properly.
When screening takes place by school medical staff or during routine doctor checks, the condition is more likely to be spotted at an earlier age.
Common causes of scoliosis
Scoliosis can be classed as non-structural or structural. Non-structural scoliosis is caused by certain factors that aren’t related directly to problems with the spine itself, such as:
- Poor posture
- Leg length discrepancy
- Back muscle spasm
In these cases, the scoliosis goes away when the primary problem is treated.
Structural scoliosis is generally caused by a problem within the spine, although it is possible that the problem began elsewhere. An example is in neuromuscular problems like muscular dystrophy where a muscle imbalance can primarily cause non-structural scoliosis. However, after time, the scoliosis turns into structural scoliosis.
Problems in the spine that cause non-structural scoliosis include:
- Congenital defects such as hemivertebra, where one half of the vertebral body (the thick oval segment of bone forming the front of the vertebra) does not develop
- Uneven or abnormal growth of the vertebra
Congenital scoliosis caused by abnormalities in the vertebra is rare but serious and can require early surgery.
Most commonly, structural scoliosis appears without a known cause and when this is the case, it is called idiopathic scoliosis. Idiopathic structural scoliosis can occur at different stages of life:
- During the first 3 years (infantile idiopathic scoliosis)
- From 4 to 10 years of age (juvenile idiopathic scoliosis)
- From 10 to 15 years (adolescent idiopathic scoliosis)
Scoliosis that appears during age 10 to 15 years (during puberty) is the most common type of scoliosis. It tends to develop during a growth spurt and most often in girls. It can also run in families, suggesting that genetics play a part. Studies of patients with scoliosis have also found biochemical changes within the spine but it is still not known if this causes the onset of the condition.
To diagnose scoliosis, your doctor will look at your child’s history and perform a physical examination to establish how severe the curvature of the spine is. Your doctor will also look to rule out any factors that may be causing the scoliosis. They will ask your child to bend forward so that they can check for any asymmetry and will use an instrument called a scoliometer to measure the angle at which your child’s body is rotated. If the angle of trunk rotation (ATR) is found to be more than 7 degrees, an x-ray will be necessary.
If your child requires an x-ray, it will be taken in the standing position so that the doctor can:
- Check the alignment of your child’s spine
- Measure the degree of curvature – the severity of scoliosis is diagnosed based on the angle of the curvature and this is determined by a measuring technique used on the x-ray film (the Cobb method).
- Assess the age of the spine and whether there is still growth left – knowing how much growth is left is important because scoliosis tends to get worse as the spine continues to grow
For severe curvature, a side-bending x-ray may also be needed to check how rigid the curve is. In some cases, your doctor may even suggest a magnetic resonance imaging (MRI) scan to rule out any underlying problems with the spine.
Most curves are mild (less than 20 degrees) and in these cases they remain mild. As mild scoliosis does not cause any symptoms or cosmetic issues, treatment is generally not recommended. Check-ups and observation will likely be advised.
Children who have not yet reached puberty may be checked annually and undergo an x-ray to review the curvature. If your child is a teenager going through a growth spurt, there is a chance that the scoliosis could worsen. In this case, your doctor will do a check every 3 to 6 months.
By age 15, when growth has usually stopped or slowed down, the curve of the spine is unlikely to get worse. At this age, if the curve is found to be less than 20 or 25 degrees, it is likely that your child will not be significantly affected by the condition.
Curvature which is above 25 degrees, or which is found to be worsening at each checkup, will need treatment that involves the use of a brace.
As mentioned, more severe curvature of the spine in young children does tend to get worse over time. Whilst bracing does not straighten the spine, it does help to prevent it from getting worse. The scoliosis brace that is commonly fitted nowadays is made of thermoplastic with corrective pads built inside. It is fitted from under the arms down to the hips and must be worn for 16 hours a day (as opposed to 23 hours for previously used braces).
A brace is usually worn until around age 15 when the growth spurt stops. In the final year of treatment, your child will be slowly weaned off the brace, with your doctor advising every 3 months regarding reduced wear.
Surgery may be required when bracing has not helped to control the scoliosis and the curve has gone beyond a 40 to 45 degree angle. Surgery involves fusing the curved area of the spine to stop it from curving further. The side effect is that this also stops the spine from growing, so it is important to wait until the child has reached complete growth. Sometimes this is not an option, for example in young children who have particularly severe scoliosis. In this case, a limited fusion may be done.
During a spinal fusion, your doctor will connect two or more of the bones in the spine (vertebrae) together. This stops them from moving independently. Your doctor will also place bone or a material similar to bone, in between the vertebrae. To hold the spine straight, metal rods, hooks, screws or wires are used while the bone material fuses together.
For young children who are experiencing rapid growth and worsening of scoliosis, your doctor can fit a rod that can be extended as your child grows. The rod is attached to the top and bottom sections of the curved part of the spine, and tends to be lengthened every 6 months.
As with all surgery, there are risks of complications and with spinal surgery, these include bleeding, infection, pain or nerve damage. In rare cases, the bone may not heal and further surgery may be required.
After being fitted with a brace, it is important to follow the advice given to you by your doctor and ensure that it is worn for the required time period.
If surgery has taken place, your child may need to wear a brace for up to 6 months afterwards. They may also need to wait for up to 6 weeks before returning to school and sport may need to be avoided for around a year. The exact aftercare and timescales involved will be individual to your child and dependent on how they have responded to surgery. Your doctor will be able to guide you.