Diagnosing and treating scoliosis: What parents need to know
When parents learn that their child has scoliosis — curvature of the spine — two of the first questions they ask is what caused it and how is it treated.
Most of the time the cause is unknown, although sometimes other medical conditions such as muscular dystrophy and cerebral palsy can contribute to developing it. The condition is most common in adolescents, especially girls, and is most often noticed by their pediatrician at their annual visit.
Parents may be able to see the curve in their child's spine or may notice that their child's hips or shoulders are uneven — one hip or shoulder is higher than the other — or that one shoulder or set of ribs is slightly forward of the other due to the twisting in their spine. I've found that parents are more likely to notice an issue in the summer, when kids are wearing bathing suits and the curve is more noticeable.
Scoliosis is diagnosed via X-ray. Once the diagnosis is confirmed, the physician and family begin to form a treatment plan, which is determined by the child's age and severity of the curve.
Many children with scoliosis have only a small curve in their spine. With a 20-degree or less curve, kids can be observed to make sure it doesn't get worse and only need treatment if the curve becomes more severe or is causing pain.
More severe curves are treated with a brace or surgery. Kids who are still growing and have curve of more than 25 degrees will have a brace. Bracing has come a long way over the years and isn't the restrictive device it once was. Today, the brace can be hidden under clothes and is worn 13 to 16 hours a day, including while sleeping.
Kids take it off for all sports and activities and it's important to know that needing a brace does not prevent kids from continuing with normal activities.
The brace will not “fix” scoliosis; rather, it will help keep the condition in check and is meant to prevent progression of the curve. For example, if a curve is 25 degrees and the brace stops the curve from worsening and the child has no pain or problems from the curve, then the condition is managed and the curve is OK as is.
The brace is only used when kids are growing, so diagnosing scoliosis early is key to getting this treatment.
If despite the brace, the curve continues to progress past 45-50 degrees, the curve is greater than 50 degrees to begin with, or the child is experiencing an increase in pain, surgery is often recommended. The procedure consists of a spinal fusion and is meant to stabilize the curvature and gain some correction.
In addition to monitoring, wearing a brace, or having surgery, I encourage patients to engage in a special form of physical therapy called the Schroth method, which is specifically designed for those with scoliosis and focuses on building core strength and posture training.
Parents who are concerned that their child may have scoliosis should have their child evaluated by an orthopedic surgeon.
• Children's health is a continuing series. This week's article is courtesy of Dr. Andrea Kramer, a pediatric orthopedic surgeon at Advocate Children's Hospital.