Scoliosis is a spinal condition characterized by an abnormal spinal curve that can occur in the cervical (neck), thoracic (upper and middle back), or lumbar (lower back) regions. A spine affected by scoliosis typically curves into an “S” or “C” shape. Any curve greater than 10 degrees is considered scoliosis, and curves over 25 degrees often require treatment. When the curve exceeds 45-50 degrees, surgery may be recommended.
Spinal curvature can lead to visible signs, such as uneven shoulder (one shoulder appearing higher than the other), prominent shoulder blades, and uneven rib humps with one side of the back protruding when bending forward.
Because pain is rare in children with scoliosis, it can be challenging to detect early. However, untreated scoliosis can lead to significant health issues, including breathing difficulties and severe posture problems.
Regular screenings can help identify scoliosis early, allowing for timely intervention. It is important to note that most curves are small and do not require any treatment. For those curves that do require treatment, options may include observation, bracing, therapy, or surgery in more severe cases to prevent curve progression and reduce the risk of long-term complications. By prioritizing early diagnosis and appropriate treatment, we can significantly improve outcomes for children with scoliosis, ensuring a healthier future.
Types of Pediatric Scoliosis
Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, affecting 2%-4% of adolescents, especially girls over age 10. During growth spurts, curves can progress at a rate of several degrees per month, with the fastest progression typically occurring before puberty or the start of menstruation. These patients are otherwise healthy, and the curve is usually picked up by a family member or the pediatrician. For small curves, only observation is necessary. Slightly bigger curves can require bracing or physical therapy. Only large curves that will continue to progress into adulthood require surgery to fix the problem.
Neuromuscular Scoliosis
Neuromuscular scoliosis is the second most common type of scoliosis, often affecting children who are unable to walk due to neurological or muscular diseases like cerebral palsy, muscular dystrophy, spinal muscular atrophy, or spina bifida.
Muscle imbalances cause abnormal spinal curvature, which can lead to complications, such as thoracic insufficiency syndrome, a life-threatening condition where the rib cage does not allow adequate lung function. Patients with neuromuscular scoliosis may also experience related spinal issues, such as kyphosis, where the spine curves excessively forward.
The treatment for neuromuscular scoliosis varies on the underlying disorder and individual needs and can include observation, bracing, wheelchair modifications, and surgery.
Early-Onset Scoliosis
Early-onset scoliosis is spinal curvature from any cause that appears before age 10.
If fusion of the spine happens at such a young age, lung growth can be restricted, leading to complications, such as thoracic insufficiency syndrome (TIS). Therefore, instead of spinal fusion, surgeons use growth friendly treatments such as elongation-derotation-flexion (EDF) casting or magnetically controlled growth rods (MAGEC) to help guide spine growth. In some cases, EDF casting can resolve the scoliosis with no further treatment needed. MAGEC rods control the curve, while allowing the spine to continue growing.
Congenital Scoliosis
Congenital scoliosis is a rare spinal condition that results from abnormal spine formation in the womb and is present at birth, affecting approximately one in 10,000 individuals. Congenital scoliosis often coexists with other health issues, including other congenital anomalies of the heart, kidneys, and spinal cord. Additional work up is often required and can include MRI of the spine, as well as evaluations by other specialists forming a multidisciplinary team. Treatment of congenital scoliosis is tailored to each patient’s individual anatomy.
Causes and Risk Factors for Pediatric Scoliosis
Pediatric scoliosis is often idiopathic (no known cause), but several factors can contribute, including:
- Family history
- Neuromuscular conditions (e.g., cerebral palsy, muscular dystrophy)
- Spinal injuries, infections or tumors
- Growth
Females are more likely to develop severe scoliosis than males, although it can affect both genders.
Signs and Symptoms of Pediatric Scoliosis
- Uneven shoulders or hips
- Excessively tilted pelvis or hips (pelvic obliquity)
- Head not centered over the body
- One shoulder blade or hip appears higher
- Rib cage or spine twists visibly, especially when bending forward
If you notice any of these signs, consult a health care provider for an accurate diagnosis.
Diagnoses and Tests for Pediatric Scoliosis
Doctors may use several methods to diagnose scoliosis:
- Physical Exam: A forward bend test (Adams test) helps reveal spinal curvatures or asymmetries in the shoulders, ribs, and hips. The physician also touches the spine to check for deviations and muscle imbalances.
- Medical History: A detailed medical history, including family history, is important as scoliosis can be hereditary.
- X-rays: X-rays show the degree of curvature and affected parts of the spine, crucial for accurate diagnosis and treatment decisions.
- Magnetic Resonance Imaging (MRI): An MRI checks for neurological concerns related to the spine and gives a comprehensive view of the spine’s soft tissues. MRI is particularly valuable for diagnosing non idiopathic scoliosis, which may arise due to underlying conditions such as Chiari malformation, syrinx, or tethered cord syndrome.
Treatment for Pediatric Scoliosis
Nonsurgical Options
Mild scoliosis often does not need treatment, but doctors monitor progression with regular check-ups and x-rays.
For growing patients with curves that are 25 degrees or greater, bracing is the foundation of nonoperative treatment. There is a randomized-control trial (BrAIST) study that showed the effectiveness of bracing to prevent curve progression in adolescent idiopathic scoliosis.
Physical therapy is used to improve core and back muscle strength, which can help with back pain. Additionally, scoliosis-specific physical therapy is used as an adjunct to bracing in patients with smaller curves.
Scoliosis Surgery
For more severe cases, surgery might be necessary. Surgical options utilized at CHLA include:
- EDF Casting: Plaster or fiberglass cast is applied to the patient with a special mold to allow for improvement in the spinal curvature.
- Spinal Fusion: Metal rods allow the spine to straighten and stabilize, preventing the curve from getting worse and promoting bone fusion of two or more bones over time.
- Vertebral Body Tethering (VBT): This option uses a flexible cord to improve the curve by manipulating the growth of the bones in the spine.
- Magnetic Expansion Control (MAGEC) Growing Rods: For children with early-onset scoliosis, these magnetic rods adjust with growth, minimizing the progression of the spinal curvature.
- Vertical Expandable Prosthetic Titanium Ribs (VEPTR): VEPTR provides spinal support while promoting thoracic space expansion, improving alignment and lung function.
- Halo Gravity Traction: A ring is placed on the skull and the patient is admitted to the hospital. Weights are added to a pulley system to allow for safe, incremental correction of large curves.
Scoliosis Care at Children’s Hospital Los Angeles
Our spine specialists are experts in both nonoperative and surgical treatments for patients with scoliosis. Our patients have access to top-notch orthotists, who make braces customized to the patient’s curve pattern and body habitus. Patients are also referred to physical therapy for core-strengthening and scoliosis specific exercises. Read more about the comprehensive care and treatment options we offer through our Children’s Spine Center.