Scoliosis in Children

Scoliosis is a term used for a curvature of the spine and it can effect children from ages 2-17.  The most common age for Scoliosis to develop is in adolescence between ages 10-17.  The large majority of cases effect girls about 90% of the time.  There are several types of scoliosis and causes but the most common type is referred to as Idiopathic Scoliosis.  Idiopathic means “of unknown cause” as the true cause for scoliosis is still unknown.  There is a genetic tendency towards scoliosis but it represents about only 30% of cases hence the vast majority of cases occur in healthy subjects with no family history of scoliosis.

There are several theories on what causes scoliosis, from hormonal imbalances, asymmetric growth plate maturation and muscle imbalance, but  no definitive cause that has been determined.  Research, however, continues to be done and new methods for predicting scoliosis are being developed.  A genetic screening test called ScoliScore has been developed and has been validated for use on Caucasians between the ages of 9-13 with mild curves below 25 degrees.  The ScoliScore is used to predict the likelihood of curves progressing past 40 degrees.

In the absence of genetic tests we can look at the research into curve progression in relation to age and with relative assurance predict whether a curve will progress or not.  In 1984 reseachers Lonstein and Carlson followed 727 children with idiopathic scoliosis. In there study they found that there was a “direct relationship between the incidence of progression and the magnitude of the curve, and an inverse relationship with chronological age and Risser sign”. In other words a larger curve in a younger, less mature child was more likely to progress than a smaller curve in an older, more mature child.

On X-ray the spine with a scoliosis would appear to cause pain for that person.  However, a the majority of scoliosis cases in children cause no pain.  Therefore scoliosis can go undetected and become quite advanced without being noticed.  S type scoliosis curves can give an outward appearance of normal while hiding large curves internally.  We recommend that all children be screened for scoliosis at least 2 times a year as early intervention is critical to successful treatment.  In cases where there is a genetic predisposition to scoliosis in a family it is not unheard of to begin scoliosis treatment on scoliosis curves a small as 15 degrees.

Treatments for scoliosis are numerous, with some being better than others.  Traditional orthopedic treatment is going to follow the standard protocol of watch and wait on smaller curves.  Followed by bracing for curves above 25 degrees to 40 degrees and surgery for curves above 40 degrees with a high likelihood of progression.

Bracing takes many forms from traditional hard braces like the Milwaukee brace and Boston Brace to soft braces like the SpineCor brace.  It is our recommendation that any curve above 20 degrees be treated.  Our rationale is based on the fact that even though we can fairly accurately predict which curves will and won’t progress we still can’t predict at 100% and if we can prevent further deformity or progression than that should be the goal.