Pediatric Orthopaedics

Scoliosis

Definition:

Scoliosis is defined as a curvature of the spine. Scoliosis can occur at any age and for many different reasons. All types of scoliosis have in common a three-dimensional spinal curvature.

Common Symptoms:

Scoliosis is usually not symptomatic. In general, children and adolescents with scoliosis do not experience pain or dysfunction. Idiopathic scoliosis, the most common type, is usually noticed during routine school screenings or primary care physical examinations. Occasionally, patients will notice that one shoulder is lower than the other, one side of their chest is more prominent, or one hip is higher. When scoliosis is painful, the patient must be carefully evaluated for underlying spinal abnormalities. Other forms of scoliosis, associated with neuromuscular or congenital problems, fall into a special category that is treated differently than idiopathic juvenile and adolescent scoliosis.

Physical Examination:

Children with spinal curvature should be evaluated by a physician experienced in treating spinal deformities. The physical examination will evaluate shoulder height, leg lengths, spine and trunk deformity, and neurologic function (including all reflexes). In addition, the patient's skin should be evaluated for abnormal pigmentation, and the degree of ligamentous laxity should be assessed.

Laboratory and Radiographic Examination:

Radiographs of the entire spine, from the head to the pelvis, are used to evaluate the individual vertebrae and the type of deformity. Occasionally, other tests such as an MRI, are necessary for a complete evaluation. In certain instances consultation with a neurologist is necessary. In general, blood tests are not required for evaluation.

Causes:

There is no known cause for juvenile or adolescent idiopathic scoliosis. Scoliosis is probably caused by a combination of genetic and environmental factors. Although certain families have a definite genetic predisposition for scoliosis, no specific gene has yet been identified. The known causes of scoliosis include cerebral palsy, muscular dystrophy, myelomeningocoele, connective tissue abnormalities (e.g. Marfan's Syndrome), spinal cord malformations and tumors, congenital malformations of the spine, and neurofibromatosis.

Treatment Options:

The GOAL of treatment is to prevent a child from developing a curve that will become progressively worse during adult life. The curve should be no worse than 50 degrees when the child is mature. The treatment will depend upon the type, cause, and severity of the curve. For idiopathic scoliosis, treatment is based upon the amount of growth remaining and the degree of curvature as measured on an x-ray. Children with mild (less than 25 degrees) curves can be closely observed by repeating xrays and examinations every four to six months. Children with moderate (25 to 40 degrees) curves who have significant remaining growth are treated with braces, which attempt to halt the progression of the curve. Children with advanced (greater than 50 degrees) are considered for surgical treatment.

Complications:

Advanced curves, greater than 100 degrees, can lead to pulmonary and cardiac problems in adult life. Patients with scoliosis do not have a higher incidence of back pain in adult life.