Proper treatment for scoliosis may help children to lead active lives

Hospital for Special Surgery in ManhattanOct 12 2010

Scoliosis may sound like a frightening diagnosis, but proper treatment enables children with the condition to lead normal, active lives.

Scoliosis refers to an abnormal curvature of the spine. Small curves are a normal part of spine anatomy and are not cause for concern, according to Dr. Daniel Green, a pediatric orthopedic surgeon at Hospital for Special Surgery in Manhattan. But when the curvature exceeds a certain range, children require medical attention.

"Many cases of scoliosis are mild, and periodic checkups may be all a child needs," Dr. Green says. "But youngsters with a curve that continues to increase may need treatment."

Scoliosis tends to run in families. The most common type is called "idiopathic scoliosis," which means the cause is not known. However, studies show that scoliosis is not caused by poor posture, the use of backpacks or any type of exercise. It affects girls ten times more often than boys.

Scoliosis is often first detected during a routine visit to the pediatrician or during a school screening. "Screenings at school are an important safeguard for many children, especially those who may not have a regular healthcare provider," says Dr. Green. He worked with the New York State Society of Orthopaedic Surgeons to advocate for the continuation of scoliosis screenings in New York schools.

The development of scoliosis is usually gradual and painless. A curve can develop without a parent or child knowing it, until it becomes more pronounced. Viewed from behind, a normal spine appears as a straight line from the base of the neck to the tailbone.

Signs of scoliosis:
•one shoulder appears higher than the other
•the waist appears uneven
•one hip looks higher than the other
•the ribs appear to protrude on one side
•the child seems to be leaning to one side when standing

Parents who notice any sign of scoliosis, however subtle, should take the child to the doctor for an evaluation, according to Dr. Green. If a child does have scoliosis, early diagnosis and treatment lead to a better outcome. Although rare, severe cases of scoliosis with a large curve magnitude can cause back pain, fatigue, difficulty breathing, and can affect the heart and lungs.

The diagnosis is based on a physical examination and x-rays. A curve of greater than 10 degrees on an x-ray is considered to be scoliosis. "Treatment depends on the age of the child, the degree of the curve and how much the child will continue to grow. The goal is to slow or prevent progression of the curve and to improve the way it looks," Dr. Green explains.

For patients with smaller curves, the pediatric orthopedist may recommend continued observation. For more significant curves, the best treatment may be a brace to correct the condition, according to Dr. Green. Some braces are worn throughout the day and evening, and other braces are worn only for sleep. It's important for the child to wear the brace as instructed. Most children get used to their brace after a short time.

For children with more advanced scoliosis -- those with a curve of 45 degrees or more -- surgery may be recommended. Scoliosis surgery is a complicated operation that takes several hours. When choosing a surgeon and hospital, parents should make sure the physician specializes in this type of surgery and is highly experienced in the procedure, according to Dr. Green. Parents and children should also feel comfortable with the doctor and make sure he or she takes the time to answer all of their questions.

"Performed by an experienced surgeon, the operation generally results in an excellent correction of the curve and significant improvement in spinal alignment," Dr. Green says. "Left untreated, a curve that continues to progress may eventually affect heart and lung function. Done later in adult life, surgeries are lengthier and tend to have a less satisfactory result."

People can check a hospital's ratings on the Internet and make sure it has a good reputation. For more information about scoliosis, visit www.hss.edu/peds.