What parents should know about scoliosis & early detection

Scoliosis is a condition where the spine curves sideways rather than following a straight line.

It affects up to 3-4 % of people, and most commonly develops during teen growth years between the ages of 10 and 14. Scoliosis is more common in girls than boys, and tends to run in families.  

If curves are mild, they typically do not cause problems. However, severe curves can cause back pain, trunk asymmetry, and even affect breathing. Getting treatment early can stop high-risk curves from getting worse.

Recognizing the signs of scoliosis

“While many cases of scoliosis don’t require treatment, recognizing the signs as early as possible can set the stage for the best course of therapy for some at-risk curves,” said David Roberts, MD, pediatric orthopaedic surgeon with Endeavor Health.

Pediatricians look for telltale signs like rib asymmetry, uneven shoulders or hips, or a visible curve in the spine. “Sometimes parents may notice asymmetry,” said Dr. Roberts.

Early detection through screening

It’s important for parents to schedule regular checkups for their children so any issues like scoliosis can be detected early.

Curves can be picked up in a routine screening by a pediatrician, which is done as part of routine well visits typically from age 10 to 14 for girls, and 12 to 16 for boys.  

“Screening is recommended because we know that if you are able to identify the curve when it first develops, this allows earlier treatment and the opportunity to improve outcomes,” said Dr. Roberts.

Scoliosis screening consists of a simple physical exam with a forward bend test that makes it easier to spot a rotation of the ribs. If the screening exam is abnormal, X-rays are done to confirm the diagnosis and evaluate the curve.  

“When scoliosis is found, referral to a pediatric orthopedic specialist with expertise in scoliosis is recommended,” explained Dr. Roberts.  

A pediatric orthopedic surgeon will make an individualized treatment plan based on the curve severity and child’s age and developmental stage.  

Watchful waiting, bracing most common treatments

For mild cases, the treatment may only be watchful waiting and observation over time, because low-risk curves often stay in the mild range on their own. Repeated exams and X-rays are done at regular intervals.  

The Endeavor Health Orthopaedic & Spine Institute at Skokie Hospital has a specialized low-dose X-ray machine, which is preferable for repeated X-rays for children, said Dr. Roberts.  

For at-risk moderate curves, children are treated with a brace. “The threshold for bracing starts with a 20-25 degree curve depending on the child’s age and risk of progression,” said Dr. Roberts. “We know that bracing can prevent the need for surgery in most children if treatment is started early.”

Depending on the severity of the curve, a custom-made spine brace may be prescribed either full-time (18 hours per day) or, in some cases, only at night (8 hours per day). “The best type of brace depends on the type and location of the curve” explained Dr. Roberts.  

In addition to bracing, specialized physical therapy, known as the Schroth method, may be recommended. Physical therapists trained in this treatment develop individualized exercises designed to stretch, strengthen, and stabilize the spine specific to the type of curvature.

Surgery to correct scoliosis allows return to all activities

If the curve progresses to the severe range, surgery is recommended to correct the curvature. Most often, this is a posterior spinal fusion, and in some cases, other surgical procedures may be necessary.

Fortunately, spinal fusion is often successful treatment for severe scoliosis.  

Following surgical recovery and rehabilitation, most children return to full activities and can play sports and lead fully normal lives, added Dr. Roberts.

“Once the spinal fusion is healed, we want kids to continue to be active and return to normal life, and most will do this within a few months with modern techniques for scoliosis correction.”

“The most important thing is early diagnosis and to connect with a specialist to determine the best treatment as soon as a spinal curve is discovered,” added Dr. Roberts.