Condition Basics

What is scoliosis?

Scoliosis is an abnormal curve in the spine. The spine curves from side to side in an "S" or "C" shape rather than being straight. The spine also may be twisted.

What causes it?

In most cases, the cause of scoliosis is not known. Scoliosis usually starts in the preteen years. In some cases, scoliosis is severe enough to need treatment. A curve in the spine may get worse as your child grows, so it is important to find any problem early.

What are the symptoms?

In children and teens, scoliosis typically doesn't cause symptoms and isn't obvious until the curve of the spine becomes moderate or severe. The child's spine may look crooked, or the ribs may stick out. Most of the time scoliosis doesn't cause pain in children or teens.

How is it diagnosed?

Doctors usually diagnose scoliosis by checking to see if your child's back or ribs are even. If the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.

How is scoliosis treated?

Mild cases of scoliosis usually don't need treatment. Physiotherapy may be an option. If the curve gets worse, your child may need to wear a brace. In severe cases, your child may need to have surgery.

Symptoms

In children and teens, scoliosis typically doesn't cause symptoms and isn't obvious until the curve of the spine becomes moderate or severe. It may first become noticeable to a parent who sees that the child's clothes don't fit right or that hems hang unevenly. The child's spine may look crooked, or the ribs may stick out.

In a child who has scoliosis:

• One shoulder may look higher than the other.
• One hip may look higher than the other.
• The child's head isn't centred over their body.
• One shoulder blade may stick out more than the other.
• The ribs are higher on one side when the child bends forward from the waist.
• The waistline may be flat on one side.

What Happens

Most cases of scoliosis are mild. They involve small curves in the spine that don't get worse. Usually a doctor examines the child every 4 to 6 months to watch for any changes.

In moderate or severe cases of scoliosis, the curves keep getting worse. During periods of growth, such as during the teenage growth spurt, the curves may get worse. Mild to moderate curves often stop progressing when the skeleton stops growing. Larger curves may get worse throughout adulthood unless they are treated.

As scoliosis gets worse, the bones of the spine move toward the inside of the curve. If it happens in the upper part of the spine, the ribs may crowd together on one side and spread apart on the other side. The curve may force the spinal bones closer together. The spinal bones on the outer edge of the curve may also get thick.

When to Call a Doctor

Call your doctor to have your child evaluated for scoliosis if:

• You see a curve in your child's spine.
• You notice that something about your child's posture looks unusual. Examples are ribs that stick out, one shoulder that is higher than the other, one hip that is higher than the other, and an uneven waistline.
• You notice that your child's clothes don't fit properly or that the hems don't hang evenly.
• A school screening program recommends that your child see a doctor.
• Your child has back pain that doesn't go away.

Watchful waiting

If you suspect that your child has a spinal curve, ask a health professional to look at it. Early detection could lead to early treatment and could prevent a curve from getting worse.

If the results of a school screening program suggest that your child may have a spinal curve, follow up with your doctor. Most curves that are found through school screening programs are normal variations in the spine or mild scoliosis. These curves usually need only regular observation.

Examinations and Tests

Scoliosis testing usually starts with questions about the child's past health, plus a physical exam. The exam includes a simple test to see if the child's back or ribs are even. The child bends forward at the waist, arms hanging loosely and palms touching. If one side is higher than the other, an X-ray of the spine may be done. A scoliometer can be used to measure and estimate the rotation of the spinal curve.

Skeletal age is also a helpful measure to find out the risk that the curve will get worse.

If someone in your family has scoliosis, your children should be checked regularly.

Neurological testing may be done on children who have scoliosis. These tests look for certain disorders that are often linked with scoliosis, such as cerebral palsy or muscular dystrophy.

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Treatment Overview

The goal of treatment for scoliosis is to prevent the spinal curve from getting worse and to correct or stabilize a severe spinal curve.

Most cases of scoliosis are mild and don't need treatment.

Treatment is based on the type of scoliosis, the child's age, the size of the curve, and the risk of the problem getting worse. This risk is based on age at diagnosis, the size of the curve (as measured using X-rays of the spine), and skeletal age.

• Mild curves are usually checked by the doctor every several months until the bones stop growing. This is to make sure that the curves aren't getting worse.
• Moderate curves may need to be braced until the bones stop growing. The brace can keep the curves from getting worse.
• Severe curves or moderate curves that are getting worse may need surgery.

Physiotherapy may be an option. But it may not be helpful for some children.

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Self-Care

• Keep follow-up visits with your child's doctor.
• If your child has a brace, follow instructions for wearing it.
• Offer your child lots of hugs and emotional support. A child, especially a teen, may feel bad about wearing a brace. If your child seems very sad or depressed for a long time, have your child talk to a counsellor.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
  • If your child is not taking a prescription pain medicine, ask your doctor if your child can take an over-the-counter medicine.
• Do not give your child two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Ask your doctor about what type of daily activity is safe for your child.

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Surgery

Surgery may be used to treat severe scoliosis. It usually involves stabilizing the spine and keeping the curve from getting worse by permanently joining the vertebrae together (called spinal fusion).

Other techniques are sometimes used. One technique is called instrumentation without fusion. Devices such as metal rods are attached to the spine. They can stabilize a spinal curve without fusing the spine together.

Surgery may be an option if:

• Your child has a moderate to severe curve, and the curve is getting worse.
• Your child has pain or trouble doing daily activities.

Experts have different opinions about the timing of surgery to treat scoliosis in young children. Spinal fusion stops the growth of the fused part of the spine. So some experts believe that surgery should be delayed until the child is older. But even after surgery, the rest of the spine will grow normally in children who are still growing.

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Brace Treatment

For children with moderate curves, the research shows that wearing a brace generally works to keep curves from getting worse as the child grows. The more the child wears the brace, the better it works.

But wearing a brace can be emotionally hard on preteens and teens, who don't like to feel different. So family support is important. A common reason for bracing not working well is that the child doesn't wear it as prescribed, usually because the child is embarrassed. A brace can also be uncomfortable.

Here are some ways family members and your child's friends can help.

• Make sure that your child feels comfortable during brace fittings.

  For example, fittings include chest measurements. Allow your child to request a same-sex technician, if one is available. This can help your child feel more involved and at ease during treatment.

• Treat the brace like a tool that's helping your child.

  Try to make it just a routine part of your child's—and your family's—life.

• Encourage your child to learn how the back brace can help.

  This knowledge may help your child deal with questions, or even teasing, at school and elsewhere.

• Encourage your child to talk about the brace with friends.
• Listen to your child's concerns.

  Ask your child how you and their friends can help.

• Show your child how to find online forums.

  Forums where preteens and teens talk about their experiences with a back brace can help give your child the courage to keep going. Your child can take part in online discussions and learn all kinds of advice, from what kinds of clothes work best to what to say on a date.

• Observe your child's frame of mind.

  If you think that your child may feel isolated or depressed because of the back brace, ask your doctor for help.

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