Pediatric Scoliosis

Scoliosis refers to an unusual bending of the backbone, resulting in a curved shape. Normally, the spine has a natural curvature in the forward and backward directions. However, scoliosis causes the spine to twist and form a sideways curve. The severity of these curves can range from as little as 10 degrees to more than 100 degrees.

Pediatric and adolescent scoliosis is a condition characterized by an abnormal sideways or rotational curvature of a child’s spine. The severity of scoliosis can vary, ranging from mild to severe. For individuals with mild scoliosis, regular check-ups with their doctor may be sufficient. However, those with more pronounced cases may require the use of braces or undergo surgical intervention.

Types of Pediatric Scoliosis

Pediatric and adolescent scoliosis can be classified into three distinct types:

Idiopathic scoliosis: This is the most common type, where the cause is unknown (“idiopathic”). It often has a genetic or hereditary basis, as it tends to run in families.
Congenital scoliosis: This is a relatively uncommon condition characterized by an abnormal curvature of the spine that is present at birth. It arises from developmental abnormalities during fetal development.
Neuromuscular scoliosis: This type of scoliosis is caused by abnormalities in the muscles and nerves that support the spine. Conditions such as cerebral palsy, spina bifida, and muscular dystrophy are examples of underlying conditions that can lead to neuromuscular scoliosis.

Symptoms of Pediatric Scoliosis

The symptoms of pediatric and adolescent scoliosis can vary depending on the severity of the curvature and the underlying cause. Here are some common symptoms to be aware of:

Uneven shoulder or hip alignment: One shoulder or hip may appear higher or more prominent than the other, resulting in an asymmetrical appearance.
Uneven waist or rib prominence: The ribs or waistline may be more pronounced on one side, leading to an uneven or twisted appearance.
Uneven spine: When observed from the back, the spine may display an abnormal sideways curvature or rotation.
Back pain: Some individuals with scoliosis may experience mild to moderate back pain, particularly as the curvature progresses or if the condition is left untreated.
Fatigue and muscle fatigue: Prolonged periods of standing or physical activity may lead to muscle fatigue and general fatigue, particularly in cases of more severe scoliosis.
Limited range of motion: In some cases, scoliosis can restrict the flexibility and range of motion in the spine, making certain movements or activities challenging.
Breathing difficulties: Severe cases of scoliosis, especially those affecting the chest cavity, can potentially interfere with lung expansion and cause breathing difficulties.

It’s important to note that some individuals with scoliosis may not experience noticeable symptoms, particularly in cases of mild curvature. Regular check-ups with a healthcare provider, especially for children and adolescents, can help identify scoliosis early, even in the absence of obvious symptom.

Causes of Pediatric Scoliosis

The causes of pediatric and adolescent scoliosis can be categorized into different types based on the underlying factors:

Idiopathic Scoliosis: This is the most common type of scoliosis in children and adolescents, and its exact cause is unknown. However, idiopathic scoliosis is believed to have a genetic or hereditary component, as it tends to run in families. It may be influenced by multiple genes and environmental factors.

Congenital Scoliosis: This type of scoliosis is present at birth and occurs due to developmental abnormalities in the formation of the spine during fetal development. It can result from vertebral malformations, such as fused or partially formed vertebrae.

Neuromuscular Scoliosis: Neuromuscular scoliosis is caused by underlying neuromuscular conditions that affect the muscles and nerves supporting the spine. Examples of such conditions include cerebral palsy, muscular dystrophy, spina bifida, spinal muscular atrophy, and other neuromuscular disorders.

Syndromic Scoliosis: Certain genetic or chromosomal disorders can be associated with scoliosis. These syndromes may include conditions like Marfan syndrome, Ehlers-Danlos syndrome, Down syndrome, and others.

It’s important to note that while the causes of pediatric and adolescent scoliosis are diverse, the specific cause of scoliosis may not always be identifiable in individual cases. In idiopathic scoliosis, for example, the interplay between genetic and environmental factors is not yet fully understood. Proper diagnosis and evaluation by healthcare professionals are crucial in determining the underlying cause and developing an appropriate treatment plan.

Diagnosis of Pediatric Scoliosis

The evaluation process for scoliosis typically involves several steps:

Initially, your doctor will take a detailed medical history to assess the presence of any family history of scoliosis or potential factors such as birth defects or trauma that might contribute to the spinal curvature. Next, a physical examination will be conducted, which involves assessing your child’s back, chest, pelvis, legs, feet, and skin. The doctor will examine the alignment of the shoulders, the centering of the head, and the levelness of opposite sides of the body.

The doctor will also ask your child to bend forward, allowing for a thorough examination of the back muscles and the detection of any asymmetry or height differences in the rib cage. During the examination of the limbs, the doctor will evaluate if they are of equal length and check for signs of abdominal muscle strain that could potentially contribute to spinal curvature.

Following the physical examination, the doctor may request an X-ray of the spine to confirm the diagnosis of scoliosis. The X-ray will be taken while your child is standing to capture the complete view of the spine. The doctor will measure the degree of curvature based on the X-ray image, and curves exceeding 25 degrees may require treatment.

If scoliosis is confirmed, your doctor will refer you to an orthopedic spine specialist who specializes in the treatment of spinal conditions.

Complications of Pediatric Scoliosis

If the scoliosis is left untreated, it can potentially lead to various complications:

Progression of the Curve: Scoliosis curves have a tendency to worsen over time, especially during periods of rapid growth. Without appropriate treatment, the spinal curvature may continue to progress, leading to increased deformity and potential health implications.
Increased Physical Discomfort: As the spinal curve becomes more pronounced, individuals may experience an increase in physical discomfort, including back pain, muscle fatigue, and limited range of motion. This can affect daily activities, physical performance, and overall quality of life.
Psychological and Emotional Impact: Scoliosis can also have psychological and emotional consequences, particularly in adolescents. The visible deformity and potential body image concerns may lead to self-esteem issues, social anxiety, and emotional distress.
Respiratory Problems: Severe scoliosis curves, particularly those that affect the chest cavity, can compress the lungs and restrict lung function. This can result in breathing difficulties, reduced lung capacity, and an increased risk of respiratory infections.
Cardiovascular Complications: In severe cases, scoliosis can affect the positioning and function of the heart. Significant spinal curvature can lead to compression of the chest cavity, impacting heart function and potentially causing cardiovascular issues.
Skeletal Irregularities: Untreated scoliosis can cause structural changes in the spine and surrounding bones. This can lead to uneven wear and tear on the joints, spinal imbalance, and potential long-term skeletal deformities.
Digestive and Abdominal Issues: Severe spinal curvature can exert pressure on the abdominal organs, potentially leading to digestive problems, reduced appetite, and nutritional deficiencies.

It is important to note that the progression and complications of scoliosis vary depending on the individual and the severity of the condition. Timely diagnosis, regular monitoring, and appropriate treatment interventions can help minimize the risks and manage potential complications effectively.

Treatment of Pediatric Scoliosis

The treatment approach for pediatric and adolescent scoliosis takes into consideration several factors:

The specific type of scoliosis.
The type and severity of the spinal curve.
Family history of scoliosis.
Age of the child.
Remaining growth years until skeletal maturity.

In most cases, children with scoliosis have mild conditions that require regular monitoring every four to six months. If the doctor observes that the spinal curve is worsening, they may recommend the use of a custom brace to prevent further progression.

In situations where the brace fails to effectively control the spinal curve or if the initial curve is already severe, surgery may be necessary. Typically, surgery is recommended for curves exceeding 45 degrees. Surgical intervention has proven to be highly effective in treating severe scoliosis.