Pediatric orthopedic specialists at UW Health evaluate and treat scoliosis, a disorder of the spine that results in twisting and bending of a normally straight spine.
What is scoliosis?
Scoliosis is a disorder of the spine that results in twisting and bending of a normally straight spine. For some people, the curve gets worse as they grow, and a brace is necessary. For a few people, spinal surgery is needed to correct the scoliosis. Scoliosis affects about one in 1,000 children. Whether your child has mild, moderate or severe scoliosis, UW Health pediatric orthopedists can help.
When is scoliosis first noticed?
Scoliosis usually starts when a child is 6 or 7 years old and gradually gets worse with growth. Parents will occasionally detect some asymmetry in shoulder height or unequal hip prominences. Children may also notice that their clothes fit differently or that one side of their back is more prominent when sitting.
In the majority of patients, however, scoliosis is hard to detect with the untrained eye. It is usually detected by a primary care physician during a well-child exam or during a school screening test.
What causes scoliosis?
In 10 percent of patients, scoliosis may be associated with conditions such as spina bifida, cerebral palsy or muscular dystrophy. For most people, however, the cause of scoliosis is not associated with any disease. This is referred to as idiopathic scoliosis. In idiopathic scoliosis the individual bones are considered normal although they tend to twist on each other, producing a spinal curvature.
Even though the majority of patients have parents without scoliosis, certain researchers believe idiopathic scoliosis is due in part to genetic makeup. If a person has scoliosis, it does not guarantee that his or her child will have it; yet a slightly higher chance is possible.
How is idiopathic scoliosis measured?
If it is determined that a child may have scoliosis, the pediatric orthopedic specialists at American Family Children's Hospital can evaluate the severity of the condition using a series of X-rays. The X-rays help to determine if the scoliosis is idiopathic (unknown origin) or congenital (the result of abnormal bone development).
From the X-rays, our physicians can also determine the degree and severity of curves in the spine and the progression of the curve. Most curves measure from 10 to 50 degrees. Although X-rays are used to determine the type of treatment, a small degree of variation exists when comparing different X-rays. A change of five degrees in measurements is usually needed to document an actual curve progression.
What happens to the curves in idiopathic scoliosis?
In rare cases small curves will improve with time. In general, however, the curves in idiopathic scoliosis either stay the same or uniformly increase in size during periods of rapid growth. Small curves tend to stabilize with maturity; however curves greater than 50 degrees can slowly progress even in skeletally mature individuals.
Why is it important to detect and treat idiopathic scoliosis?
Generally, people who have mild to moderate curves live normal lives. Their sole concern in regard to the deformity is to ensure that their children are closely watched for the development of scoliosis.
Scoliosis does not affect one's eventual ability to have a child via normal birth, and it does not usually get worse during pregnancy. Mild to moderate scoliosis is not usually a problem if epidural or spinal anesthesia is ever needed.
Severe idiopathic scoliosis can affect one's life in three ways. First, severe scoliosis can result in an unusual physical appearance of the back, shoulders and hips. Second, people with severe scoliosis may occasionally have back pain in the area of the curve. In some instances, the pain can become severe enough to alter one's life. Finally, scoliosis can be life threatening in extremely rare instances when the curve progresses to greater than 100 degrees. In these highly unusual instances, the spinal deformity can cause serious problems with heart and lung function.
What are the goals of treatment in idiopathic scoliosis?
UW Health pediatric orthopedists try to prevent curves from progressing to greater than 50 degrees by the time a person reaches skeletal maturity. If a curve is close to 40 degrees at maturity, curve progression is unlikely to occur and lead to further problems.
How is scoliosis treated?
Prior to any treatment, your UW Health pediatric orthopedist works with you to get a careful history and perform a detailed exam to rule out any non-idiopathic causes of scoliosis. Once idiopathic scoliosis has been detected, treatment is based on an individual's curve magnitude and remaining growth potential.
Observation: People who are still growing and have curves that are less than 25 degrees are carefully followed with X-rays that are taken every five months. Further treatment such as bracing or surgery is only required if the curve continues to progress. If a patient has finished growing, X-rays only need to be taken every other year until no further progression is documented.
Bracing: For people who are still growing, curves from 25 to 40 degrees may be treated with bracing. Bracing is designed to hold the curve and to prevent further progression during the remaining growth spurt. Bracing does not correct curves, but holds them at an acceptable level until a person is finished growing. Bracing is never used for individuals who have finished growing. Most braces used today are low profile and lightweight, making them more acceptable to wear than those used a generation ago.
Surgery: For people who are still growing and have curves that measure 45 to 50 degrees, surgery is usually required. Surgery is also required in mature individuals whose curves continue to progress beyond 50 degrees, or who have significant back pain. Although surgery is rarely needed, it is a highly successful measure that both straightens the spine and prevents further progression of the curve to life-threatening magnitude.