Scoliosis

Scoliosis occurs when the bones in your spine do not form a straight line (when viewed from behind), but instead are abnormally curved. Your spine has 4 normal curves, like alternating “C’s”.  The issue occurs when there is a greater than normal angle in these 4 curves.  Any abnormality in the spine’s naturally occurring curves is measured in degrees, and referred to as a Cobb angle.  This Cobb angle is critical to know, since it will determine how well a patient responds to treatment, whether that treatment is surgery, physical rehabilitation, or requires the use of a spinal brace for scoliosis.

When you think about the spine being 3-dimensional, the spinal cord can form an abnormal curve from the side/lateral view, causing a twist, or corkscrew in the spine. This twist can be especially problematic, causing long lasting health problems.

The spine is made of many bones called vertebrae that are connected by cartilage. Cartilage is an elastic tissue that acts as a shock absorber and reduces friction, and keeps bones from rubbing together when you use your joints.  This cartilage sits in between the vertebrae in your spine, and gives people the flexibility to bend and stretch, as well as balance when they are walking.

The earlier in a  child’s life that you can treat Scoliosis (sko-lee-OH-sis), the greater likelihood that you can stop the curve from getting worse. There is currently no known cause or prevention method for Scoliosis, so it is important to be on the lookout for anything abnormal in your child’s spinal curvature.

Besides the annual school scoliosis screening, it is important that parents get regular check ups for their children, especially before the child has a growth spurt. The earlier the diagnosis and treatment plan, the sooner a scoliosis specialist can implement a plan to keep the curve from getting worse during puberty, or growth spurts. Although parents live busy lives, they can keep an eye out for uneven shoulders or hips, a tell-tale sign of scoliosis. Unfortunately, as children mature, especially after 8 years of age, they start wanting more privacy, and parents are less likely to notice anything unusual.

Nearly three million children are diagnosed with Scoliosis each year. Many of these cases are discovered by school nurses across the US, who perform Scoliosis screenings looking for abnormal curvatures in prepubescent, and adolescent children each year.  

Typical treatment, depending entirely on the severity of the curve, will be recommended by healthcare providers to treat scoliosis. Amongst the options available to physicians specializing in Scoliosis are physical rehabilitation, the use of a Scoliosis brace, and surgical intervention. It is critical to understand the pros and cons of each alternative before embarking on any particular corrective path, as your choice, especially when caught early, can dictate whether your child’s curve can be stopped before becoming too severe, or become completely alleviated when caught and treated by scoliosis specialists that are specifically trained to treat scoliosis. 

Pediatric Orthopedic specialists (Children’s doctors who treat bone and muscle problems) will typically group scoliosis into several different types. By knowing the type of Scoliosis a child has, the physician can address the problem to produce the best possible result. These are the most common types of Scoliosis as follows:

1. Adolescent Idiopathic Scoliosis (AIS)
2. Congenital Scoliosis
3. Neuromuscular Scoliosis  
4. Degenerative Scoliosis

The most commonly diagnosed type is Idiopathic scoliosis or Adolescent Idiopathic Scoliosis (AIS) commonly referred to as late onset idiopathic scoliosis.  Although children can get this type at any age, most children are diagnosed with Idiopathic scoliosis at around the time they are experiencing puberty while going through a growth spurt. Scoliosis experts do not know why this type of scoliosis occurs in some children, but it does tend to occur more often in some families, even though there is no known genetic link. That being said, Adolescent Idiopathic Scoliosis occurs in about a third of the children that have families with a history of this condition. The most prevalent type of scoliosis, Adolescent Idiopathic Scoliosis, predominantly presents in adolescent girls.  With a female to male ratio of 4:1, this type of scoliosis affects girls considerably more, especially for curves with angles exceeding 40 degrees.  When it exceeds 40 degrees, the female to male ratio more than doubles to 10:1.

Congenital scoliosis is another type of scoliosis. However, this type most often occurs when there is a developmental issue with the vertebrae of the baby in the womb, before birth. Unfortunately, this type of problem may not be noticed until they turn about two years of age, or from 8 to 14 years of age. This type of scoliosis occurs about once in every 10,000 births.

A chronic medical problem affecting the muscular or skeletal system in a child can cause scoliosis. This type of Scoliosis is called Neuromuscular Scoliosis.  Children that have muscular dystrophy, cerebral palsy, Marfan syndrome, Spina Bifida, or osteogenesis imperfecta are susceptible to scoliosis, as well as any that have tumors or growths on their spine. A severe spinal trauma can also cause scoliosis in children.

Age related degeneration of the spine can cause an abnormal curve that is greater than 10 degrees in grown adults. This abnormal sideways curve in a gown adult is called Degenerative Scoliosis (it can also be called osteoarthritis of the spine, more commonly  known as spondylosis). 

Parents sometimes overlook the incredible fact that not all children diagnosed with Scoliosis need treatment. Only about a third of those children diagnosed with scoliosis will need some type of treatment. The other two-thirds will need consistent check ups and monitoring to insure the small curves do not worsen. 

It is important to remember that small curves typically do not cause issues in children, but large curves can create huge problems like arthritis of the spine, breathing issues when ribs rub against the pelvis, and severe discomfort and muscular pain. This is not to mention the mental anguish of any noticeable deformity in your child’s body that may be caused from self-image concerns, or trying to fit in with their peers at this critical stage in life. 

The main way that scoliosis specialists monitor these small curves is through x-rays and as aforementioned, Cobb angles from initial diagnosis, and examination, to subsequent examinations.  By monitoring the Cobb angle changes, they can decide, based on the age of the patient and severity of the scoliosis, whether to treat the child with physiotherapy, bracing, or surgery. Along with the consideration of their age and how much more a child will grow, the treatment will also depend on the type of scoliosis.

The great news for children diagnosed with mild scoliosis, comprising about two-thirds of all children diagnosed with this problem, is that they will not require any treatment except for regular monitoring during follow up physical exams. The second largest group ( about 75% of this group), those with moderate scoliosis,are generally treated with scoliosis bracing. Of the remaining patients, spinal fusion surgery is the prescribed treatment plan.

When children have a curvature of about 25 degrees or more, pediatric orthopedic doctors typically recommend scoliosis bracing for children and teens, provided they are still growing. Although children using scoliosis bracing can achieve curve reduction, the primary goal of the bracing treatment is to stop, or keep the curve from progressing to the point where spinal fusion surgery becomes necessary.

A scoliosis specialist should prescribe the least aggressive and least invasive option to help your child, taking all factors into consideration already discussed- age, growth, and scoliosis type. So, for the majority of children diagnosed with this issue, the treatment plan will be to simply monitor for changes in the curve and verify for any worsening or progression of the curve. Then, for moderate scoliosis, anything greater than a 25 degree Cobb angle, will be treated with scoliosis bracing. Lastly, for those with moderate or severe scoliosis, spinal fusion surgery is the recommended treatment plan.

Those children diagnosed with moderate scoliosis can expect to wear their brace from 12 to 22 hours per day. However, the number of hours prescribed really does depend on a custom tailored approach to each child’s individual situation. A scoliosis specialist will take into consideration many factors which include your child’s age, their future growth potential, the degree of curvature, and/or progression of that curve during multiple visits. By taking these factors into consideration, the physician can create the most effective individualized schedule for brace wear that will take your child’s growth pattern and scoliosis type into consideration. There are some instances when full-time bracing is not possible, and night-time bracing is used, especially in patients with mild curves or those where compliance and cooperation by the child are present. 

Wearing a scoliosis brace is often the most prescribed treatment plan for scoliosis. Children, especially preteens and adolescents, that are still experiencing rapid growth, typically do not follow rigid rules, particularly when there is the possibility of some type of social stigma or alienation from their peer group. They are more likely to not comply with wearing a brace, especially if it is noticeable. 

Unfortunately, parents are limited in being able to make a child comply and wear their brace for the recommended number of hours per day. Hence, it becomes paramount to choose a scoliosis brace that will work best for their child’s condition, mental health, and well being. The important thing is to remind your children that not wearing the brace for the time prescribed can lead to a worsening curve that will mean spinal fusion surgery in the future, with all of it’s longer term implications and drawbacks. We discuss the different types of scoliosis bracing options in our in depth braces section, and the pros and cons associated with their use and efficacy. 

Many of the braces available today can be worn under normal clothing. This helps children considerably as they are more likely to comply with the number of hours they are prescribed to wear them, since the braces are essentially hidden. It will take time and effort from both the child, and the parents, to get used to wearing the scoliosis brace, as initially there may be complaints stemming from physical discomfort as well as some originating from the social stigma of having to wear the “noticeable” brace. This is especially true if they participate in team sports. Parents should encourage their children to speak openly to their friends about wearing the brace, so that it becomes easier over time to deal with any social anxiety, or stigma related to wearing it.  

The best course of action if you are actively engaged in a team sport or physical activity, is to discuss the possibility of removing your brace during sports activities with your scoliosis specialist. The individualized plan may allow for you to remove the brace while you participate in games and/or practice, as long as you put it back on as soon as you are done. However, the stricter the adherence to the treatment plan prescribed by your physician, the less likely your scoliosis curve progresses, and the less likely surgery will be needed in the future. 

When your child is diagnosed with moderate scoliosis, whether it is Idiopathic, congenital, or neuromusclular (trauma/muscle or skeletal disease related), there is a high probability that their treatment plan will require the use of a brace. The brace is designed to prevent their spine from growing more curved or twisted. A scoliosis brace creates pressure against your child’s spine where an abnormal curve/curves exist, essentially inducing a straightening of their spine. There can be multiple pressure points, depending on the number of curves in your child’s back.  By putting pressure on the outer edge of your child’s spine where their curve/s exist, the pressure causes the spine to elongate and forces them to stand up straighter. 

 There can be a single, double, and in rare occasions, a triple curve in your child’s spine. The type of curves most commonly diagnosed in children are right thoracic (28 percent) and left lumbar curves (22 percent). 

Studies show that once a child has been diagnosed with moderate scoliosis, or scoliosis with a Cobb Angle greater than 25 degrees, scoliosis braces are the most effective treatment not requiring surgery to keep your curve from worsening. 

Physical therapy alone will probably not be enough to stop your child’s curve from progressing if they have moderate scoliosis. Although physical therapy is an important component of strengthening the spine through specific exercises, wearing  a brace in the manner, and for the time prescribed by a specialist, is more effective in keeping your child’s curve from progressing, than physical therapy by itself. By pairing your physician who specializes in scoliosis, with a physical therapist that can custom tailor a comprehensive scoliosis specific exercise program for your child, you can get the best results for your child. A physical therapist will evaluate things such as posture, flexibility, and muscle strength in order to design an exercise program that will help strengthen and stretch your back muscles and help your back get strong. 

There are different types of Scoliosis braces available to treat your child’s condition, and depending on several factors, a scoliosis brace may  be prescribed by your scoliosis specialist.

The most important thing to remember in treating moderate scoliosis, or scoliosis where the curve is greater than 25 degrees, is not that there is a cure per se, but the fact that a brace is intended to halt any progression or worsening of the curve in your child’s spine. In a study published by The New England Journal of Medicine in 2013, the study concluded that 

“Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear”, and that 72 percent of the patients wearing braces had treatment success.