Learn more about:
- When and why your child may need surgery.
- What surgery is like.
- Life with spinal fusion surgery.
- Complications and risks.
If you have questions for Dr. Shah and Dr. Shannon, post them in the comments section on Facebook.
Q: When a pediatrician first discovers a small curve in a young child, what is the best way to approach the new diagnosis?
A: Kids under age 10 are more likely than older kids to need further monitoring, or even sometimes intervention from an orthopedic surgery team. If you detect any asymmetry of the back, or trunk, or shoulders, it’s important to have them come in and see us for a further evaluation. This includes the child’s history and a physical exam, oftentimes x-rays, and determines if this is scoliosis and what type of future monitoring is needed.
Q: How does growth affect a curvature?
A: In the most common type of scoliosis (adolescent idiopathic scoliosis), it’s the buckling of the spine, a rotation in the curvature. Most of the time it stays mild, but in cases that progress, that tends to occur while the children are growing. If it gets up to a certain amount, then as an adult, those cases continue to progress. While children are growing, and the growth plates are tilted away from the horizontal, then those growth plates have the potential to get more and more curved. The younger you are when you have scoliosis, the more of a risk you have for curve progression. If you’re already grown up, the risk of your curve continuing to progress is extremely low. While you’re still growing, you do have a risk and some of those curves will keep getting worse. That may need further monitoring and treatment.
Q: Is scoliosis genetic?
A: We know from older studies that scoliosis runs in families. Things are much more sophisticated in terms of genetic studies now. We have genome-wide association studies now that can study large populations of unrelated patients who might be more at risk for scoliosis. There lots of barriers, however. We have ethnic and racial differences with scoliosis. We don’t have a great animal model for scoliosis to study different interventions. It is clear that it runs in families and we do take that seriously, but, we can’t change the genetics right now and we don’t have a lot of diagnostic tests to determine who may be at risk for progression.
There are numerous groups that are working on this, but we have yet to identify a gene which can be influenced and perhaps change the nature of the curve.
Q: Can a patient outgrow scoliosis?
As you fill out, and you go from being a middle-schooler who is skinny and scrawny to being an adult, the appearance of asymmetry on your ribs definitely gets covered over as you fill out more. So you can’t tell from the outside that a person has mild curves in their spine, but if you take an x-ray of them, you will probably still see the mild curves and mild scoliosis that’s there. So you never really outgrow it, but if it stays mild, it doesn’t tend to bother you as an adult.
Q: What about medium sized curves or large curves, and what sort of treatment is available?
A: For large curves (when the angle between the most tilted vertebrae is more than 50 degrees), those curves tend to keep getting worse as you go through adulthood. For those patients, we do offer the operation to straighten and stabilize the spine.
For patients that look like they are headed in that direction (patients that generally have a curve of at least 25 degrees that have a lot of growth remaining) we try to treat them to prevent the curve from progressing. The main treatment for that is a brace that molds the ribs, the waist, and the torso to try to guide the growth of the spine. It’s useful while you’re growing and most useful during the rapid growth spurt (usually middle school, early high school age).
There’s also a program of physical therapy we think that can prevent the curve from progressing at least while you’re doing the exercise program. Either for mild or moderate curves for kids that are already being braced.
The primary thing is for parents not to panic when a pediatrician mentions they might have a curve. It’s really to find out more information. To find a scoliosis specialist and get an x-ray would be the next steps.
Q: When should kids get checked?
A: Most kids should have an annual visit with their pediatrician. Most of the time, we don’t see adolescent idiopathic scoliosis until age 10. A significant scoliosis is usually visible during that exam. Kids who have scoliosis that shows up around age 10 often do not have it at a younger age.
Q: Do people get pain when they have scoliosis?
A: About a quarter of people with back pain have scoliosis. Most of the time, when we see new kids with scoliosis, they don’t have back pain. We have to always ask about things like that, but sometimes they’re unrelated.
Q: What role do vitamins play in bone health and specifically scoliosis?
A: We know that the body uses calcium and vitamin D as the building block for bone. Vitamin D helps the body store calcium in the bones and make them thicker and stronger. Exposure to sunlight helps the body take the vitamin D from food and make it into the active form to use. Children with scoliosis have been found to have low vitamin D. In some cases. Children with scoliosis that have low vitamin D have more curve progressions. It is worthwhile to be on a vitamin D supplement if you are on a scoliosis treatment regimen. It has not yet been shown to decrease the curvature or prevent bracing if you take a vitamin D supplement.
Q: Does twisting to pop/crack your back cause scoliosis?
A: We’re not aware of any specific maneuver causing scoliosis, even wearing a backpack on your right shoulder for the entire 6th grade. Scoliosis is not a postural issue, it’s a structural issue that develops from the inside because of bone asymmetric growth. Not a specific maneuver, sport or backpack.
Q: Which kids are most eligible for bracing?
A: Braces are only instituted for kids that still have significant growth remaining. For the cases that look like they are getting progressively worse, or that show up with a curve that’s at least 25 degrees, then those kids will be prescribed a brace. The brace we commonly use wraps around the torso, it goes under the armpits and down to your waist. It pushes on the spine through the ribs to help unbend the spine and un-rotate the spine and help push it forward, to guide the growth. The orthotist will create the brace specific to each child and provide padding and align it for comfort.
The more you wear the brace the more it works. The New England Journal of Medicine conducted a great study on the effects of bracing.
Q: When is surgery necessary?
A: Surgery is necessary for curves that are showing they will continue to progress, even after the child has finished growing. We expect that curves that have shown progression, despite bracing, or that were never braced, but are more than 50 degrees. It seems as if that’s too much buckling and twisting for the spine to be able to continue to support itself. It seems to be the right thing for teenagers that have a curve that’s predicted to get worse to go ahead and have it stabilized and we’re usually able to make it much straighter in the process of doing that.
Q: If the spine is fused, will the back be stiff?
A: From a theoretical standpoint, there is motion limitation in the area of the surgery. But after surgery, parents see how well their kids are doing and there’s really not a motion restriction in sports or a robot-like appearance that might be what people expect and/or fear.
Q: What about curves under 10 degrees?
A: For curves under 10 degrees, we call that spinal asymmetry. Occasionally those tend to progress and become scoliosis. those are so common that they are okay. It’s unlikely, and would take a very long time, to progress from a curve like that to needing consideration for a brace. We are happy to see kids with mild curves. To learn more, visit the Nemours Spine and Scoliosis Center.