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Scoliosis: The Crooked/curved Spine

Scoliosis is abnormal curvature of the spine. The spine does have some normal curves if you look at it from the side (going in and out from the neck to the lower back). However, if you look at the spine from the back, it appears to be straight (side-to-side curvatures aren’t normal).

Scoliosis is relatively common in kids (esp. teenage girls) and something your pediatrician should be looking for during your child’s well checks. It’s a simple examination of your child’s back. If there is more than a 10 degree curve, it is considered scoliosis. There are different types of scoliosis.

Causes of scoliosis:

  1. Idiopathic (fancy scientific name for ‘we don’t know why it happened’): The most common form, usually presents in early adolescence. Interestingly, while “idiopathic” is most common, scoliosis does seem to run in families, so there is some sort of genetic component.
  2. Complication of underlying medical problems: Polio, muscular dystrophy, and central nervous system disorders.

Signs your child may have scoliosis:

  1. The spine isn’t straight when looking at it straight-on
  2. Uneven or rounded shoulders
  3. Uneven hips
  4. Uneven ribs or sunken chest
  5. The appearance of leaning to one side
  6. Back pain (less common)

How is scoliosis diagnosed?

  1. Physical exam: Typically the doctor stands behind the patient and has the child bend forward with the finger tips reaching towards the toes (and slowly stand up). The key is having the child’s feet even and legs straight. If the spine doesn’t look straight, then you may be dealing with a case of scoliosis. FYI, about half the states in the US do “scoliosis screening” in the public schools. I remember getting checked in Jr. High and being so embarrassed that my gym teacher was going to see my bra (how funny, right?).
  2. X-rays: The diagnosis is confirmed with x-rays of the back. “Scoliosis films” are a bit different than a typical x-ray of the back (since you are trying to get the entire spine in the x-ray). The angle of curvature is then measured (the actual degree of curvature is called a Cobb Angle).

How is scoliosis treated?

Treatment entirely depends on the degree of the curvature. Generally, there are 3 types of treatment. Options 2 and 3 are usually done under the care of a specialist called an orthopedist (a.k.a., bone specialist).

  1. Observation only: If the curvature is less than about 25 degrees (I’ve seen orthopedists use anywhere from 20-30 degrees for this cut off value). Often times, as a child/teen grows, the spine will straighten out (or at least not get worse) and watchful waiting in the mild cases is completely appropriate.
  2. Bracing: This approach is used for kids who have curvatures in the 25-50 degree mark. There are a few different kinds of braces used depending on the location of the curvature and orthopedic preference. Typically braces are worn most of the day and continued until the child is done growing (late teen years).
  3. Surgery: This is used when the curvature is 50 degrees or more. The surgery typically involves fusion of the affected vertebrae and metal rods and screws for stabilization.

The problems and pitfalls:

In medicine, it is very easy to identify a problem and tell someone what they need to do to fix it. The reality is that implementing the solution is often easier said than done. It is very easy to tell a teenager to wear a brace essentially all of the time. In practice, it is very hard to get them to do it.  According to the AAP, only 50% of kids with scoliosis wear their braces. It interferes with body image, activities, and affects a kid’s self-confidence. If your kid has been diagnosed with scoliosis and you’re having trouble getting him or her to wear the brace, you may want to consider a referral to a mental health professional.

Thanks, J.K., for your topic suggestion of addressing scoliosis. Hope it helps!