Scoliosis in Children and Adolescents
Early onset scoliosis
Early-onset scoliosis is the abnormal lateral curvature of spine that occurs in children who are less than 5 years. There is no known cause for a young child to have developed scoliosis at this age. This condition includes children with congenital scoliosis (present at birth) and infantile scoliosis (birth to 3 years). Early onset scoliosis is associated with congenital chest deformities, neuromuscular disorders such as cerebral palsy, muscular disease, and tumor. Early-onset scoliosis generally affects boys more often than girls.
Early onset scoliosis does not cause any pain but it may affect your child’s overall appearance.
Your doctor identifies the condition by performing ‘Adam’s forward bend test’. During this test your child is asked to bend forward and your doctor looks for the symmetry of the hips and shoulders, and the curve of the spine from the sides, front and the back. X-ray of the spine is taken to measure the degree of severity of curvature. An MRI scan of the entire spine is often recommended to detect any neurologic changes.
Treatment of scoliosis is based on the physician’s assessment of the spinal curve, its cause, the age of the child, and the expected growth of the child. Treatment options include non-surgical and surgical treatment. Non-surgical treatment consists of observation, bracing, and casting.
- Observation: The child is examined every 3 to 4 months to monitor the curve. After the observation if your child’s curve is progressing then additional treatments may be required.
- Bracing: Your doctor may recommend wearing a brace to prevent worsening of the curve.. Braces do not treat the condition but it helps to slow the progression of the curve. However bracing is not effective in neuromuscular scoliosis and congenital scoliosis.
- Casting: Cast is applied to your child’s trunk which controls and corrects the curve by allowing the spine to grow in a normal manner. The cast is changed regularly until the curvature is reduced.
If the conservative treatments do not control the curving, your doctor may suggest surgery. Children who are at a risk of developing respiratory and cardiac problems because of progression of curve may be recommended for surgery. Surgical modality includes insertion of implants such as growth rods, vertical expandable prosthetic titanium rib prostheses (VEPTR), and spinal staples. These implants help in correcting the curvature without interfering with the growth of the spine.
Growth rods are expandable devices that are attached to the top and base of the spine with the help of internal fixators such as screws and hooks.
Vertical expandable prosthetic titanium rib prostheses are artificial devices that are placed between your child’s ribs to move them apart. It straightens the spine and increases the space for lungs and improves pulmonary function.
Spinal stapling is a minimally invasive technique that involves implanting metallic staples across the growth plate of the spine. This procedure modulates growth and corrects the curve without spinal fusion procedure.
Adolescent Idiopathic Scoliosis
Scoliosis is a medical condition characterized by an abnormal lateral curvature of the spine, either to the left or to the right. Adolescent idiopathic scoliosis (AIS) is a type of scoliosis that occurs in children between 10 to16 years of age. The term “idiopathic” means that the cause of scoliosis is unknown; the exact cause of idiopathic scoliosis is unknown in most of the cases, but there seems to be a genetic predisposition. The incidence is higher among girls when compared to boys.
The common signs and symptoms of adolescent idiopathic scoliosis include limb length inequality, uneven shoulder levels or protrusion of one shoulder blade, walking abnormality, abnormal curvature of the spine, inequalities in the levels of the hip, uneven trouser lengths, ill-fitting clothing, and back pain.
Adolescent idiopathic scoliosis is usually noticed by a parent or detected by a teacher during a routine physical examination.
Your physician will diagnose scoliosis based on the following criteria:
- History: To diagnose the problem your doctor will ask about your child’s past and present medical history as well as any family history of scoliosis.
- Physical Examination: Yourdoctor will perform a physical examination using the forward bending or Adams test, to define the curve.
- Adams Forward Bend Test-During this test the child is asked to bend forward with the arms extended forward. Your doctor looks for the symmetry of the hips and shoulders, and the curvature of the spine from the sides, front and the back. Any abnormalities along the back could be a sign of scoliosis.
- X-ray: X-ray of the spine is taken from the front and the side to confirm the diagnosis and also to measure the degree of the curvature.
- Neurological Examination: Here the patient’s reflexes are tested and any neurologic changes are noted.
The treatment of adolescent idiopathic scoliosis is important because if left untreated, the curvature may result in significant deformity and can cause psychological distress and physical disability for your child. In addition, the deformity can have serious physical consequences. As the vertebrae rotate, the rib cage is affected, and this can lead to serious heart and lung problems. In order to compensate for the major curve and maintain the balance, the spine may develop a secondary curve above or below the AIS curve.
Treatment options include non -surgical and surgical treatment. The non –surgical treatment options include:
- Observation– If scoliosis is mild with a curve of less than 15 to 20 degrees, the child is observed for a specified period of time, to monitor the curve.
- Bracing:Bracing is recommended to prevent the progression of the scoliotic curve. It is effective in growing children with a spinal curvature between 20° and 40°.
Surgical correction of adolescent idiopathic scoliosis may be necessary if nonsurgical treatment fails and if the curvature is severe. The aim of the surgery is to correct the curve, prevent curve progression and to stabilize the spine. Scoliosis surgery usually involves spinal instrumentation (i.e. rods, screws) and fusion (bone graft) that secures the spine to stop curve progression.
Your spine surgeon can discuss all aspects of the procedure, including risks and benefits, so that you and your child are well informed. If your child develops signs and symptoms suggestive of AIS consult your doctor immediately. They are the most reliable resource to answer all your questions and help you understand the condition better.