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Childhood Scoliosis

By John P. Sheehan, M.D.

Spines are naturally curved to allow our body to flex, extend and move. These curves should only be visible from a profile angle, and the spine should appear straight from a frontal view. Scoliosis is a condition when the spine has additional curves along the side, appearing to be twisted like a corkscrew or shaped like the letters “c” or “s.”

Scoliosis can appear at any age, but most cases are diagnosed during the adolescent years or during the onset of puberty. Usually it is pointed out at a school exam or a parent may notice that their child's clothes do not fit properly (one pant leg may be longer than the other), one hip is higher than the other or maybe their child doesn't stand up as straight as he or she should.

Signs of scoliosis:

  • Shoulders or hips are different heights
  • Waist appears uneven or twisted
  • Back pain
  • Body leans to one side (or child appears to always favor one side)

Home Test

Have your child stand with his or her feet together and then lean forward, bending at the waist. If the shoulders do not line up, your child should be evaluated by a physician.

Treatment

If scoliosis is suspected, your child's physician will confirm the condition with an x-ray. A CT scan, MRI or bone scan may occasionally be used, depending on the curve. Based on the severity of the condition, and if a child is still maturing and growing, your physician or orthopaedist will determine whether observation, bracing or surgery is the most appropriate method of treatment.

Observation
Most scoliosis cases fall under observation treatment. Curves less than 20 degrees can be monitored to make sure they do not present any future problems. Children who are still growing may outgrow the condition.

Bracing
Curves that are 25 to 45 degrees may be progressive and will often continue to worsen if left untreated. Bracing is the most appropriate method to help slow and stop the spine from continuing to curve. The brace will not reverse the curve, but will help straighten the spine through pressure and can be adjusted as the child grows. There are several brace options you can choose from to fit to your child's needs.

Surgery
Surgery is often recommended for curves greater than 45 to 50 degrees because the condition often progresses, even after the child stops growing. Orthopaedic surgeons can straighten and fuse the curved bones together, often putting one to two metal rods in place until the bones heal. This procedure can be done through an incision in the back or the abdomen. After surgery, the child may need to wear a brace to stabilize the spine until the healing process is complete.

Prevention

The cause of the most common type of scoliosis is unknown. But we have found that people who have a family history of scoliosis have a greater chance for developing this condition in life. Most treatments, short of bracing and surgery, have not been shown to prevent or stop scoliosis. Boys Town Pediatric Orthopaedics offers a few tips to parents to help their children develop strong and healthy bones. Keeping bones and muscles healthy may help prevent other problems from developing.

  • Growing children should consume the following amount of calcium every day:
    • 1 to 3 years — 500 mg
    • 4 to 8 years — 800 mg
    • 9 to 18 years — 1,300 mg
    *1 cup of milk = 300mg, 1 cup yogurt = 300mg, 1/2 cup green leafy vegetables = 100mg.
  • Add 400 IU's of vitamin D daily, to help bones absorb the calcium.
    *1 whole egg = 25 IU's, 3oz of Salmon = 700 IU's, 3oz of tuna = 150 IU's, 1 cup of milk = 100 IU's.
  • Weight bearing exercises such as running and gymnastics will also help strengthen bones.
  • If your child does not consume the necessary amount of calcium and other vital nutrients, talk with your child's physician about adding a multi-vitamin to his or her diet.