Clinical Reference Systems: Pediatric Advisor 10.0

What is scoliosis?

Scoliosis means that the spine curves somewhat from side to side rather than being straight down the back. The spine is made of bones called vertebrae that normally stack one on top of the other in a straight line.

Scoliosis develops gradually as your child grows. Scoliosis is usually noticed just before or during puberty when your child is going through a growth spurt. Girls get scoliosis more often than boys. Usually parents do not notice the gradual changes caused by scoliosis. The curvature is usually discovered by a doctor or school nurse. At first, the symptoms are painless and not always easy to recognize. A child with scoliosis may:

• have uneven shoulders or waist
• have a hump on one side of the back
• have one or both shoulder blades sticking out
• lean slightly to one side.

What is the cause?

There are many causes of scoliosis. Sometimes vertebrae are incompletely formed or misshapen. Sometimes children who have legs of different lengths will develop a curvature of the spine. Other times, diseases cause scoliosis. However, in children and teens the cause is most often unknown. When a cause for the scoliosis cannot be found, it is called idiopathic scoliosis.

In idiopathic scoliosis some of the vertebrae are rotated. This causes the ribs on one side of the back to stick out more, causing a hump. The muscles attaching the vertebrae to the ribs on either side may not be pulling with equal forces. This may cause one set of rib muscles to pull harder and twist the vertebrae causing them to move out of a straight line down the back.

How is it diagnosed?

X-rays are taken to diagnose scoliosis. The x-rays show the amount of curvature and sometimes helps identify a cause. Your child's legs are measured to make sure they are the same length.

What are the complications?

The amount of curvature varies widely. However, the younger your child is when the curvature starts, the worse it is likely to become. The curving of the spine usually continues to get worse until a child's bones are done growing (around age 16 for girls and age 18 for boys). Girls tend to have more severe scoliosis than do boys. A curvature in the upper back tends to get worse faster than one in the lower back. Some curvatures, if allowed to continue, can cause serious health problems or back pain later in life.

How is it treated?

If your child has a slight curvature, she just needs regular checkups by the doctor. If the curvature continues to get worse, your doctor may recommend braces and molded plastic shells called orthoses. Orthoses usually slow down further curving of the spine but do not correct the curvature that is already there. Sometimes orthoses do not slow the curving enough to prevent serious problems and surgery is needed.

Call Your Child's Physician During Office Hours If:

• You would like more information about scoliosis.

For more information see:

Scoliosis: Book List