Understanding Scoliosis in Children and Teens

“The most significant misconception about scoliosis is what causes it,” said Matthew Wagner, MD, Catholic Health Pediatric Orthopedic Surgeon. “Parents think a heavy backpack, a sleeping position, or the use of technology may have caused their child’s scoliosis. Even as research continues, idiopathic scoliosis, the most common form of scoliosis, remains with no known cause.”

What is scoliosis?

“Parents come to my office concerned about what a scoliosis diagnosis will mean for their child,” said Dr. Wagner. “Their concerns lessen once they learn more about scoliosis, how the treatment is typically nonsurgical, and that their child can live full, healthy, and active lives.”

Scoliosis is a spinal condition that causes the spine to curve sideways in an “s” shape on the right or left side. It is typically diagnosed in childhood or adolescence, with the primary onset between 10 and 15 years of age for both males and females.

Scoliosis can be broken down into two general categories that affect children and teens:

Idiopathic scoliosis is the most common type of scoliosis, though no known cause has yet to be identified. The adolescent form of idiopathic scoliosis is most common and typically presents after age 10.

Non-Idiopathic scoliosis:

Congenital scoliosis is when spinal curvature presents at birth due to structural abnormalities of the vertebra.
Neuromuscular scoliosis occurs when a spinal curvature is a symptom of a neurological or muscular disease, such as cerebral palsy, muscular dystrophy or Spina Bifida.

“Adolescent idiopathic scoliosis is what we typically refer to when we talk about scoliosis because of its prevalence,” explained Dr. Wagner. “It is the most common form of scoliosis diagnosed and treated by pediatric orthopedic surgeons.”

What are the signs of scoliosis?

Shoulders. Uneven shoulder height with one or more shoulder blades protruding.
Head. The head is not centered with the body directly above the pelvis.
Hips. Uneven hips with one or both raised or unusually high.
Waist. The waist shows as uneven.
Arms. The arms do not hang normally beside the body when standing straight.
Back. The side view of the back may look abnormal when bending forward.
Ribs. The rib cages have different heights.

Another common sign of scoliosis is when a child’s clothes do not hang straight on them.

What causes scoliosis?

The cause of idiopathic scoliosis is unknown; however, certain risk factors are associated with it. Those risk factors include:

Genetics. Research shows that genetics may play a role in developing scoliosis.
Gender. Girls are more likely than boys to develop scoliosis.
Growth spurt. Spinal curves frequently develop during periods of rapid growth.

Dr. Wagner noted that idiopathic scoliosis is rarely a source of pain for teens. Additional exams can rule out if the pain is caused by other conditions such as stress fractures (spondylolysis) or spondylolisthesis (a vertebrae slips out of place and falls on the vertebrate below it).

How is scoliosis diagnosed?

Scoliosis is often first noticed by a parent, teacher or pediatrician. Some schools offer scoliosis screenings. Scoliosis screening is also a routine part of an annual pediatric exam.

A scoliosis screening uses the Adams forward-bending test. The test looks for protrusion of shoulder blades and asymmetry of the torso or shoulder blades. A scoliometer will measure a child’s or teenager’s trunk inclination in degrees after they lean forward with their feet together and bend 90 degrees at the waist.

Scoliosis curves are measured in degrees. Scoliosis is diagnosed when a spinal curvature shows greater than 10 degrees on an X-ray.

The degree of the curve on a radiograph indicates the severity.

Less than 25 degrees is mild.
Between 25 degrees and 45 degrees is moderate.
More than 45 degrees is severe.

A pediatrician will recommend you to a pediatric orthopedic surgeon for further examination and testing if your child’s measurements indicate scoliosis. An X-ray is the most common imaging test, but your doctor may also recommend a CT scan or MRI.

“The imaging tests confirm a diagnosis of scoliosis and determine the treatment plan that will be tailored to the degree of the spinal curvature,” said Dr. Wagner.

How is scoliosis treated?

“Although pediatric orthopedic surgeons oversee the diagnosis and treatment of scoliosis, that does not imply that surgery is required to correct scoliosis,” said Dr. Wagner. “Surgery is only a consideration for extreme cases, especially those with curves greater than 50 degrees. Otherwise, we use nonsurgical treatments.”

Dr. Wagner explained that several questions have to be considered before beginning treatment, including:

Growth potential. Is the spine still growing?
Curvature degree. Is the curvature degree severe?
Curvature location. Is the curvature in a location that makes it more likely to progress?
Curvature progression. Will the curve progress?

“Once we address those questions, we tailor an appropriate treatment plan for the child,” he said.

Nonsurgical treatments for scoliosis include:

Monitoring. For mild cases of scoliosis, typically 25 degrees or less, the child is monitored into adolescence to ensure the curve is not progressing. Your doctor will recommend how often examinations and X-rays should occur.
Bracing. A brace is recommended for a child with moderate scoliosis who is still growing. The brace prevents the curve from progressing. Your pediatric orthopedic surgeon will recommend the correct type of brace and how long to wear the brace. They will also regularly check that the brace fits correctly. The amount of time per day in the brace depends on the type of brace, location of the curve, and the curve severity, but it can range from nighttime use only to 23 hours/day use.
Schroth method. The Schroth method is a specialized form of rehabilitation that combines physical therapy and exercise. Unlike a brace, it rarely prevents the curve from progressing. However, it does assist with symptoms of scoliosis, such as imbalance.

Surgical treatments for scoliosis

“Surgical treatments are only considered for a child or teenager when the curvature degree is considered severe, bracing is not effective, or there is the potential for the curvature to progress to a higher degree,” said Dr. Wagner.

The most common surgical treatment for adolescent idiopathic scoliosis is a posterior spinal fusion, which uses metal rods to straighten the spine. Typically, patients are released from the hospital within a week and can return to school between two and four weeks. Full recovery can average four to six months.

Can scoliosis “go away” without treatment?

Scoliosis requires treatment; it does not correct itself on its own.

Dr. Wagner explained that advances in treatment options ensure that scoliosis in children or adolescents can be corrected.

“They can continue their favorite activities, including recreational activities with friends and competitive sports without restrictions,” he said. “They will grow into healthy adults.”

How can a child or adolescent practice good spinal health?

“Although scoliosis is not caused by carrying heavy backpacks, sleeping positions or looking down while playing a video game or texting on a cell phone, these and other habits contribute to poor spinal health and neck/back pain,” said Dr. Wagner.

He recommends that his young patients practice good spinal health because it positively impacts their spinal health as they grow into adults. Some tips include:

Practice keeping a healthy posture.
Avoid overuse injuries when playing competitive sports.
Take a break from texting and gaming.
Stretch the lower extremity muscles, such as the quadriceps and hamstrings, before and after exercising or playing sports.
Avoid heavy lifting or using the wrong weights when working out.

Find Care at Catholic Health

Catholic Health offers orthopedic and physical therapy services across Long Island.

Find a Catholic Health doctor near you. Or call 866-MY-LI-DOC (866-695-4362).