The term ‘scoliosis’ refers to the abnormal bending of the spine. This condition may also be observed in children of ages 10 to 14 years. This article provides some information about the causes, symptoms, and treatment of this condition.
Our spine consists of many bones, which appear like blocks stacked one over the other. Its main function is to protect the spinal cord, and the surrounding nerves passing through the spine. Normally a spine should appear straight, when observed from the back, and a mirror-image letter ‘S’, from the side. Scoliosis is said to occur when the bones are not properly placed on top of each other, thereby curving the spine sideways.
Also defined as a lateral curvature of the spine, this condition could affect boys, as well as girls. In most of the cases observed in children, the condition may not be severe and might resolve with the growth of the child. However, immediate treatment would be required, in cases wherein a progression in curve is monitored. If detected and treated at an early stage, this condition would not cause permanent problems or disabilities.
The actual cause of this condition is not known, that is, it is idiopathic. The condition can affect children, right from the time of birth to adolescence.
- At the time of birth, improper or incomplete formation of the bones, like growth of spine more on one side than the other or the abnormal joining of the back bones or the ribs can cause congenital scoliosis.
- Poor posture, muscle spasm due to compressed or slipped discs, or structural abnormality like having one leg shorter than the other, can cause non-structural or mobile scoliosis.
- The condition can be genetic, especially if both parents have it, the child may also develop it. Other contributory factors could include traumatic incidents like bone fractures, radiation, or surgery involving the spine.
- Other health conditions including polio, cerebral palsy, muscular dystrophy, Ehlers-Danlos, Marfan syndrome, and osteogenesis imperfecta (brittle bone disease) can also lead to this condition.
Usually the condition remains asymptomatic until the curve becomes serious, wherein the child’s clothes seem to hang unevenly or a certain change in the posture may be observed. Also, one shoulder may seem to be higher than the other and an unequal distance between body and arm might be observed. The child would start to lean more on one side while standing, sitting, or walking and the shoulder blades, ribs, or hips will protrude more on one side than the other. In adolescent girls, one breast may appear larger than the other. In severe conditions, trouble in breathing and back pain may occur.
This condition is normally detected, during routine screening, using the forward bend test (Adam’s test), either at the school or during their regular medical checkups with the pediatrician. If the child is identified with the condition, the pediatrician would have to be consulted instantly for a confirmatory exam and correct diagnosis. During the diagnosis, the doctor would analyze the child’s medical history or the family history. The child’s shoulders, hips, legs, ribs and actions of moving and feeling things, would be observed.
An X-ray examination of the spine would be conducted, so as to carefully examine the curve or shape of the spine, and look for other problems like broken, incomplete, or fused bones. The X-ray usually consists of a standing PA (posteroanterior) and lateral X-ray of the spine, to evaluate the degree of curvature of the spine by measuring different angles along the curve (Cobb method). CT scan or magnetic resonance imaging (MRI) may also be conducted to observe the bones, muscles, brain, body organs, and blood vessels of the affected child.
The Treatment Methods
Children having mild or small curves that measure less than 20 degrees, generally don’t require treatment. However, children with rapidly progressive curves, or with curves that measure more than 30 degrees, require immediate medical attention. The two main treatments for available are bracing and surgery. In bracing, the child has to wear a cast or back brace to keep the spine from bending. Most of the braces are light in weight and small, and can be worn under clothes.
Thoracolumbosacral orthosis (TLSO), which is the most commonly used brace, is custom-molded and fits comfortably beneath the clothing. It can be worn during day and night. These braces can be adjusted as the child grows. In severe cases, the use of even a back brace might not be of much help. Under such circumstances, surgery would have to be performed. In a surgery, the bones are joined together along the curve by putting rods, screws, or wires in the spine to make it straight. The surgery does not cause much pain and usually the child would be able to start walking by the next day.
In mild cases, simple back exercises and therapies can be used to correct the posture and treat the deformity. This condition can hamper a child’s confidence, hence it is important that the child should get full emotional support from family and friends.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.