Scoliosis is the name given to the condition in which the spine curves sideways and twists on itself, causing a painless, slow abnormality in the back. It can be deforming and can shorten life if not recognized early and treated properly.
While there are many medical conditions that cause scoliosis _ such as cerebral palsy, muscular dystrophy and poliomyelitis _ in more than 85 percent of cases, the cause remains a mystery. The spinal curvature is not the result of the way the child is brought up or because of poor posture, as many parents think.
Nearly half-a-million adolescents have a curve that requires monitoring. Girls are affected four times as often as boys, and there is a tendency for this condition to occur in families. Therefore, if one member of the family has it, other members of the family should be examined, especially children. Scoliosis sneaks up on a growing child and usually is first noticed between ages 8 and 12. It frequently is not recognized for several years after its onset.
Scoliosis usually is first recognized during a school screening or by a parent. Mothers will notice that their children's hems or pant legs never seem even, or they have difficulty fitting clothes properly. When looking at their children from the back with no shirt on, parents observe that one shoulder blade is more prominent than the other, or the hips appear to be uneven.
Many school districts now screen children for scoliosis in grades 6, 7 and 8. This usually is done by a school nurse or a trained examiner, and children who demonstrate some abnormality are referred to their own physicians.
The task of screening children is challenging (there are about 24-million children in the United States between the ages of 11 and 14), but the effort is well worth it since many children with significant scoliosis are identified by school examiners, allowing for early treatment.
Parents should not panic if they see any abnormalities or if their children do not pass school screening programs. Most children in these situations have only a slight curve that needs only repeated observation by a doctor. Occasionally, a child will flunk the school screening but will not have scoliosis when checked by a doctor. Don't be upset at the school _ your child may be normally asymmetric or wasn't standing up straight for the nurse and therefore looked curved when he or she actually wasn't.
The best way to determine whether your child has scoliosis is to look at the back. If there is an unequal waistline or if the ribs in the back are higher on one side when the child bends forward, the child may have scoliosis. In addition, when standing directly behind your child, the ears, shoulders and hips should be level. If you suspect scoliosis, the child should be examined by a doctor. X-rays may be taken to confirm the problem and determine the degree of curvature.
The purpose of treating scoliosis is to stop the curve from becoming larger before permanent cosmetic problems result or damage occurs to internal organs. In the majority of cases, mild curves that are not getting worse need be checked only periodically by the doctor. If the curve remains unchanged, no treatment is necessary. Increasingly severe curves usually are seen by an orthopedist, a bone and joint specialist.
Treatment varies depending on severity and age. Moderate curves are usually treated with a brace that helps keep the spine as straight as possible during the child's adolescent growth spurt. This form of treatment continues until the skeleton is mature, about two years after the onset of menstruation in girls and between 17 and 19 for boys. Severe curves and those not responding to bracing require surgery. The operation involves a fusion of the curved portions of the spine after it is straightened as much as possible. Surgery, when necessary, is usually successful.
Fortunately, most spinal deformity in children stays the same or even disappears, and fewer than 1 percent require treatment either by braces or surgery. The problem for parents is that there is no way of knowing which way the mild curve will go. Since severe scoliosis can progress to a serious deformity, parents should continually observe their preteens and young teenagers for early signs, especially if others in the family have been affected. If there is any question, your child's doctor should be consulted since identifying scoliosis early can prevent serious problems later.
As a reminder, this column is being written to draw attention to the issues discussed. It should not be relied upon as medical advice and is not intended to replace the advice of your child's physician.
Dr. Bruce A. Epstein has practiced pediatrics in St. Petersburg since 1973. He is a member of the American Academy of Pediatrics. He is married and has three grown children.