The importance of early detection – Tips for Parents
Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years. Therefore, parents should watch for the following “tip-offs” to scoliosis beginning when their child is about 8 years of age:
- uneven shoulders
- prominent shoulder blade or shoulder blades
- uneven waist
- elevated hips
- leaning to one side
Any one of these signs warrants an examination by the family physician, pediatrician or orthopedist.
Some schools sponsor scoliosis screenings. Although only a physician can accurately diagnose scoliosis, school screenings can help alert parents to the presence of its warning signs in their child.
How can scoliosis be treated?
In planning treatment for each child, an orthopedist will carefully consider a variety of factors, including the history of scoliosis in the family, the age at which the curve began, the curve’s location and severity of the curve.
Most spine curves in children with scoliosis will remain small and need only to be watched by an orthopedist for any sign of progression. If a curve does progress, an orthopedic brace can be used to prevent it from getting worse. Children undergoing treatment with orthopedic braces can continue to participate in the full range of physical and social activities.
Electrical muscle stimulation, exercise programs, and manipulation have not been found to be effective treatments for scoliosis.
If a scoliotic curve is severe when it is first seen, or if treatment with a brace does not control the curve, surgery may be necessary. In these cases, surgery has been found to be a highly effective and safe treatment process.
Scoliosis is a common problem that usually requires only observation with repeated examination in the growing years. Early detection is important to make sure the curve does not progress. In the relatively small number of cases that need medical intervention, advances in modern orthopedic techniques have made scoliosis a highly manageable condition. Orthopedists, specialists in diseases of the muscles and skeleton, are the most knowledgeable and qualified group of physicians to diagnose, monitor and treat this condition.
Your orthopedist is a medical doctor with extensive training in the diagnosis, and non-surgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.
This brochure has been prepared by the American Academy of Orthopedic Surgeons, in cooperation with the Scoliosis Research Society (SRS), and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and SRS and its text should not be construed as excluding other acceptable viewpoints.
Kyphosis (Curvature of the Spine)
Few things bother parents more than their child’s posture. This is particularly true for an exaggerated rounding to the back. Some degree of curvature to the spine is normal. The term “kyphosis” (kI-fO-sis) is usually applied to the curve that results in an exaggerated “round-back.” A variety of disorders may be responsible for this condition. Many such disorders are listed here.
Usually, a visit to the doctor is brought on by a scoliosis screening at school, concern about the cosmetic deformity of a rounded back or pain combined with poor posture. The doctor may ask the child to bend forward so that he or she can see the slope of the spine. X-rays of the spine will show if there are any bony abnormalities. X-rays will also let the doctor measure the degree of the kyphotic curve. Any kyphotic curve that is more than 50 degrees is considered abnormal.
What are the different types of kyphosis?
- Postural kyphosis. Postural kyphosis is the most common type. It is often attributed to “slouching.” It represents an exaggerated, but flexible, increase of the natural curve of the spine. This usually becomes noticeable during adolescence. It is more common among girls than boys. It rarely causes pain. Exercises to strengthen the abdomen and stretch the hamstrings may help take away associated discomfort. But exercises probably won’t result in significant correction of the postural kyphosis. This condition does not lead to problems in adult life.
- Scheuermann’s kyphosis. Scheuermann’s (shoe-er-mans) kyphosis is named after the Danish radiologist who first described the condition. Like postural kyphosis, it often becomes apparent during the teen years. However, Scheuermann’s kyphosis will present with a significantly worse cosmetic deformity. This is particularly the case in thin individuals. Scheuermann’s kyphosis usually affects the upper (thoracic) spine. It can also occur in the lower (lumbar) back area. If pain is present, it is usually felt at the apex of the curve. Activity can aggravate the pain; so can long periods of standing or sitting. Exercises and anti-inflammatory medication help ease the discomfort. When X-rays are examined, the vertebrae and disks will appear normal in postural kyphosis. But they are irregular and wedge-shaped in Scheuermann’s kyphosis.
- Congenital kyphosis. In some infants, the spinal column does not develop properly while the fetus is still in the womb. The bones may not form as they should. Several vertebrae may be fused together. Either of these abnormal situations may cause progressive kyphosis as the child grows. Surgical treatment may be needed at a very young age. This can maintain a more normal spinal curve. Consistent follow-up is required to monitor any changes.
What are the effective treatment options?
Treatment will depend on the reason for the deformity. Most teens with postural kyphosis will do well throughout life. In some, their posture may improve over time. An exercise program may help with back pain, if present.
An initial program of conservative treatment is also recommended for patients with Scheuermann’s kyphosis. This includes exercises and anti-inflammatory medications. If the child is still growing, the doctor may prescribe a brace. The child wears the brace until skeletal maturity is reached.
Treatment Options: Surgical
Surgery may be recommended if the kyphotic curve exceeds 75 degrees. The goals of surgery are:
- Reduce the degree of curvature by straightening and fusing the abnormal spinal segments together
- Maintain the improvement over time
- Alleviate back discomfort, if present preoperatively