Understanding Adolescent Curvature of the Spine
Myths about scoliosis abound. Many people assume that the condition stems from continual bad posture. Others believe it to be merely a condition of stooped or humped shoulders. But according to the Scoliosis Research Society, scoliosis is “a condition of a side-to-side spinal curve.” The normal spine is a straight line down the middle of the back. However with scoliosis, the spine curves to the left or right more than 10 degrees, sometimes looking like an “S” or a “c.” Though it is often difficult to detect early on, scoliosis is a treatable condition that develops most often among children and adolescents.
According to the National Scoliosis Foundation, 1 in 40 people (about 2 to 3 percent of the population) has some form of scoliosis. The condition may occur early in a child’s life, but the primary age for its onset is just prior to puberty when the normal growth spurt occurs; it is most commonly discovered between 10 and 15 years of age.
“Scoliosis that occurs in adolescence typically has a prevalence of one per thousand,” says Dr. Scott D. Hodges, a cervical and lumbar specialist at the Center for Sports Medicine and Orthopaedics. “Although an equal number of male and female patients are diagnosed with scoliosis, females have a much higher risk of progressing to the point of needing more active treatment.” The National Scoliosis Foundation claims that females are in fact eight times more likely to have a curve level that requires treatment.
Substantial research has been done to explore the causes of scoliosis, but the real cause is most often unknown. Scoliosis can be congenital, meaning present at birth, or a secondary symptom of another condition (such as spina bifida, cerebral palsy, spinal muscular atrophy or physical trauma). However, in over 80 percent of cases, no specific cause has been identified.
Scoliosis in which the cause is unknown is called idiopathic. The American Academy of Orthopedic Surgeons states that there are several different types of scoliosis that affect children, but identifies adolescent idiopathic scoliosis as the most common.
Doctors describe this most common form of scoliosis based on the age at which a person develops the condition. Idiopathic scoliosis is typically called “infantile” in children 0 to 3 years, “juvenile” in children 4 to 10 years, “adolescent” in ages 11 to 17 and “adult” in patients over the age of 18. Scoliosis does not result from heavy lifting, involvement in athletics or poor posture while sleeping or standing.
Most cases of scoliosis are mild, and if identified early, can be prevented from growing worse. The following list identifies several early signs of scoliosis.
Doctors and parents alike can look for these red flags:
• The child has one shoulder or hip that looks higher than the other.
• The child’s head appears not to be centered over his or her body.
• One of the child’s shoulder blades may stick out more than the other.
• The child’s waistline appears flat on one side, or the ribs appear higher on one side when the child bends over.
If a curve gets worse, the spine can also rotate or twist in addition to curving side to side. This can cause the ribs on one side of the body to stick out farther than the other side. In severe cases of scoliosis, an individual can experience back pain and difficulty breathing.
Dr. Hodges explains that in addition to age and sex, another risk factor for scoliosis is family history. Idiopathic scoliosis, in particular, is often hereditary. If a sibling, cousin, aunt, uncle or parent has scoliosis; a child is more prone to develop it. Of those who have scoliosis, 30 out of 100 have family members with the condition.
Physical abnormalities can also contribute to an increased risk of scoliosis. For instance, if one of the bones in a child’s spine has moved forward out of place, this may contribute to the onset of the condition. Also, children may be at risk if they have a missing leg or arm or if their limbs are abnormally short. Abnormal tissue growth occurring before birth can also lead to the development of scoliosis.
Mild curves can develop and appear gradually without notice. In some cases, a teacher first notices a child’s scoliosis. In other cases, a friend or teammate might draw attention to the problem. “It’s often the case that people don’t notice right away, and one of the main reasons for this is because scoliosis is never associated with pain in adolescents,” says Hodges. “This is why, years ago, school programs actually lined students up when they got to be a certain age and looked for it.”
Although most cases of scoliosis are mild, some children can develop spinal deformities that become progressively worse as they grow. A severe case can be disabling. This is why it is essential for a patient to see a doctor as soon as symptoms are noticed.
When a doctor first examines a child for scoliosis, he or she will likely ask a number of questions such as, “When did you first notice the problem?” and “Is it causing any pain?” A parent may be asked, “Has the child grown rapidly during the past six months?” Treatment is often based on the initial evaluation. About 10 out of 100 children diagnosed with scoliosis require treatment, which may include bracing or surgery. A child with more serious scoliosis will usually be referred to a spine specialist.
A child who has mild scoliosis is closely monitored—most often with X-rays—to determine whether the curve is worsening. If there is no progression in the curve while the child is growing and it continues to have a small degree of measurement, the patient will normally continue to be observed by a doctor and may undergo physical therapy as an adult.
In some children, curve progression will require the use of a brace in order to prevent the curve from getting worse. This is normally for curves between 25 and 45 degrees. In more severe cases, a child may need surgery to arrest the problem or straighten the spine. According to Dr. Hodges, “patients who are typically in need of surgery have curves greater than 45 to 50 degrees.” Surgery is usually postponed until a child’s bones stop growing.
A Personal Story: Haille Dinger
When Chattanooga area resident Teresa Dinger, director of marketing and communications at Siskin Hospital, took her 8-year-old daughter Haille for her routine physical, their pediatrician noticed something strange: Haille had a slight bulge on one side of her upper back when bending over. An Xray confirmed the presence of scoliosis—two 17 degree curves.
As Haille grew, the curves continued to progress, making it necessary for her to begin wearing a brace in the 5th grade. Teresa says her daughter adapted well to the brace, even getting a zebra-patterned one that “didn’t look medical.”
But by the next year, following a major growth spurt, Haille’s brace had failed to halt the progress of her spinal curves, which increased to 57 and 47 degrees. After assessing her worsened condition, Haille’s orthopaedic specialist advised that Haille undergo surgery.
Support and Hope
Teresa Dinger believes that support from family and friends makes an enormous difference to a child with scoliosis. She explains that even though she and her husband were fearful about Haille’s surgery, they tried to do everything they could to embrace the event and be strong for their daughter. “Parents should know that surgery for scoliosis is not the end of the world,” she adds.
The Dingers’ bravery paid off. According to Teresa, Haille took the whole event in stride and was extremely positive throughout her time at the hospital. Her surgery was a total success. Her spine was straightened without incident, and following the procedure, she discovered she had actually grown two inches. Now she’s a healthy, happy youngster who loves to dance and, according to Teresa, can do “just about anything she wants to.”
If you or someone you know is suffering from scoliosis, take time to educate yourself on the particulars of the condition. More information is available through the Scoliosis Research Society (www.srs.org), the leading world authority on scoliosis education and treatment. With a better understanding of scoliosis, you may be able to offer hope and help to someone you know. Don’t wait.