What is Scoliosis?

Children with scoliosis have an abnormal curvature of their thoracic and/or lumbar spine.  The thoracic spine is the part of the back with ribs and helps to form the chest.  The lumbar spine is the lower part of your back between the thoracic spine and pelvis.  When viewed from the front, the spine should be perfectly straight but children with scoliosis have an abnormal side to side curvature of their spine that often resembles the letter C or the letter S.  This is in contrast to kyphosis, where the natural rounding of the upper back is larger than normal causing the child to appear hunched forward when viewed from the side.  In some cases, both of these conditions exist simultaneously.

How is Scoliosis Diagnosed?

Scoliosis is usually suspected based on a physical exam.  Pediatricians (and many schools) routinely screen children for scoliosis, and refer them to an orthopedic specialist when they suspect the diagnosis.  Some of the findings your pediatrician looks for include holding one shoulder higher than the other, one flank appearing longer than the other, the torso shifted to either side or a prominence of the ribs or muscles on one side of the back when the child leans forward.  When one of these prominences is seen, the examining health care provider may use a scoliometer (a small device that looks like a level) to measure its size.  When there is a suspicion for scoliosis based on the physical exam, x-rays will confirm the diagnosis.  In some cases, an MRI or a CT scan may also be ordered to better visualize the problem.

What Are the Different Kinds of Scoliosis?

There are several different types of scoliosis better defined according to the disease that causes it to develop.

Neuromuscular Scoliosis

Neuromuscular scoliosis occurs in children who do not have normal functioning of their muscles in their back.  This may be due to a problem with their brain as in the case of cerebral palsy, it may be due to an intrinsic problem with their muscles as with muscular dystrophy, or it may be due to an injury to the spinal cord.  This type of scoliosis usually continues to worsen with time despite attempts at conservative treatment and even after the child has stopped growing.  Surgery is usually required to manage this type of scoliosis.

Congenital Scoliosis

Children with congenital scoliosis have a problem with the way the bones of their spine developed while they were growing inside their mother’s uterus.  Often this problem is not evident until the child is several months or sometimes several years old.  Not infrequently, these children have other congenital anomalies including problems with their heart and kidneys.  There are a wide variety of ways in which the bones can develop them properly and depending on the pattern the child may have absolutely no significant problems and require no treatment or the child may have a severely progressive curve that requires treatment at a very early age.  For large, progressive curves, one or multiple surgeries may be required.

Idiopathic Scoliosis

Idiopathic scoliosis is the most common form of scoliosis seen.  These curves developed for reasons that are poorly understood.  For some reason, one half of the spine appears to grow more quickly than the other half which causes the curve to develop.  However, what causes the spine to grow in this way remains a mystery.  This type of scoliosis can occur at any age, and is classified according to how old the child is at the time of diagnosis.

Infantile scoliosis is diagnosed by the age of three and is more common in boys and girls.  Fortunately, 90% of these curves do not require surgery and will actually resolve either with bracing or spontaneously.

Juvenile scoliosis is diagnosed between four and 10 years of age.  On like with the infantile group, these curves do not tend to go away without treatment.  Many of these curves require bracing or even surgery.

Adolescent scoliosis is the most common form of idiopathic scoliosis.  These children are older than 10 at diagnosis and many tend to have a favorable prognosis.  This form of scoliosis is much more common in girls than it is in boys.  The likelihood that these curves will get larger depends in large part upon the amount of growth they have remaining.  For example, an 11-year-old girl who has not yet entered puberty would have a much higher risk of having her curve get worse than would a 14-year-old girl with an identical curve who went through puberty several years ago.