Signs of scoliosis in children and treatment options

If you grew up being reminded to stand up straight or pull your shoulders back, you're not alone. But for three out of every 100 adolescents who are diagnosed with scoliosis, perfect posture might be out of reach without medical intervention.

Christopher Redman, M.D., orthopaedic surgeon at Children's Health℠ Andrews Institute for Orthopaedics and Sports Medicine, shares what you need to know as a parent about scoliosis.

What is scoliosis?

Scoliosis is a growth-related disorder that causes the spine to grow sideways, most often during the growth spurt before puberty. Scoliosis affects girls more often than boys.

"Most children who have scoliosis will have a mild form of the condition," says Dr. Redman. "However, sometimes the condition can get worse as the child grows, causing back, neck and rib pain; interfering with daily activities and causing breathing problems."

Are there different types of scoliosis?

Children may have one of three common types of scoliosis:

• Idiopathic scoliosis, which develops for no known cause. This is the most common type of scoliosis, accounting for 80% of scoliosis cases
• Congenital scoliosis, in which there are abnormalities in the bones of the spine that cause a curve
• Neuromuscular scoliosis, which is caused by disorders that affect the brain, spinal cord or muscular system.

Common conditions associated with neuromuscular scoliosis include:

• Cerebral palsy

• Muscular dystrophy
• Paralytic conditions
• Spinal muscular atrophy
• Spina bifida

"In neuromuscular scoliosis, the muscles and surrounding tissues are either too tight or unable to support the weight of the body, which leads to progressive spinal curvature," Dr. Redman says.

How is neuromuscular scoliosis different from idiopathic scoliosis?

Neuromuscular scoliosis can get worse quickly and affect more vertebrae than idiopathic scoliosis. Unlike patients with idiopathic scoliosis, small curves in neuromuscular scoliosis can continue to grow worse even after your child's bones are fully mature.

How can I tell if my child has scoliosis?

Most school districts screen students for scoliosis in fifth and eighth grades. You can also check for scoliosis at home to see if your child has any early signs. While your child is wearing a bathing suit and standing with their back to you, look for these signs of scoliosis:

• Uneven shoulders or one shoulder blade more prominent
• Head not centered directly over the hips
• One hip appears higher than the other
• One side of the waist looks more curved than the other
• Rib cage is more prominent on one side than the other
• Appearance of leaning to one side

If your child has one or more of these symptoms, a neuromuscular condition, or if you have a family history of scoliosis, it is important you discuss your concerns with your child's doctor. Symptoms of scoliosis typically appear between the ages of 10-12, but can appear as early as infancy in the case of infantile scoliosis, also known as early onset scoliosis.

How is scoliosis diagnosed?

Both types of scoliosis are diagnosed using X-ray images of the back. Your child's physician can use X-rays to take measurements of the spine and any curvature.

Can scoliosis be corrected in children?

Scoliosis treatment is determined by considering your child's age, skeletal maturity, how much your child is likely to grow and curvature of the spine.

"If your child has mild scoliosis, your doctor will likely monitor your child closely every four to six months to make sure the spine does not curve further," says Dr. Redman. "Curves in the upper spine are more likely to progress than curves in the middle or lower spine."

Scoliosis treatments may include bracing or surgery.

• Bracing. A brace is used to prevent small spinal curves from getting worse. It is not a tool to correct an existing spinal curve. The brace is custom made to fit your child exactly and is almost invisible under clothes. Dr. Redman recommends wearing the brace as much as possible, but for a minimum of 18 hours a day. Typically, the brace comes off after the child stops growing, when small curves are less likely to progress. Braces may not help all children with neuromuscular scoliosis. In fact, they aren't recommended often due to the risk of skin irritation and restriction on the patient's breathing. Children in wheelchairs may benefit from custom-made seat backs that help prevent spinal curves from getting worse.

Learn more about nonsurgical scoliosis treatment options including bracing, physical therapy and Schroth exercises.

• Surgery. Surgery may be recommended to straighten the bones in the spine that are severely curving. A child who has this surgery is usually up walking the next day and goes home in three to seven days. Surgery is the most effective treatment option for children with neuromuscular scoliosis. However, neuromuscular patients may have increased risks of infection and bleeding after surgery. Your child should receive care at a center with experience treating neuromuscular scoliosis to help decrease these risks. You should speak to your child's physician about all the benefits and risks of surgical treatment.
• Treatment of neuromuscular disorders. Treating the underlying neuromuscular disorder is also important to prevent and manage neuromuscular scoliosis. These treatments can vary greatly depending on a child's needs, but typically include some form of physical therapy.

Infographic: Get the facts and learn more about scoliosis and the importance of early detection.

Learn more

If you are concerned about your child and scoliosis, contact the Children's Health Andrews Institute Spine Center. The center offers treatment for neuromuscular scoliosis, as well as its underlying causes. Its spinal disorders team uses robotic-assisted techniques for spinal surgeries, which has been proven to increase the accuracy and safety of scoliosis treatment.

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