Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, most of the causes of scoliosis remain unknown.
In most cases, scoliosis is mild but some children develop spinal deformities that continue to get more severe as they grow. The term “deformity” is used to describe people with spinal curvature. It does not imply that the individual is “deformed” in any regard. Simply passing the age of puberty does not mean the patient is out of danger. Passing puberty is not necessarily a cure.
A severe spinal curve can reduce the amount of space within the chest making it extremely difficult for the lungs to function properly. In children who have mild scoliosis, we usually monitor them closely with intermittent x-rays to see if the curvature is getting worse. In many cases, no treatment is necessary because the curve does not worsen. Some parents use bracing to try to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening or to straighten severe cases of scoliosis. The symptoms that are typical have to do with the body’s posture.
Uneven shoulders, one shoulder blade higher than the other, an uneven waist line, a leg length discrepancy where one hip appears higher than the other are common findings in many patients. When scoliosis progresses, the spine will also tend to rotate or twist in addition to curving in a side to side direction. This causes the ribs on one side of the body to stick out further than on the opposite side. Many times families will notice problems on photographs before they notice them in real life. In general, you should see your spine surgeon for evaluation if you have a concern. The spine surgeon is the most knowledgeable regarding the anatomy and the problems that generally arise.
The most common reason why a surgeon would recommend scoliosis surgery is a progressive worsening in the degree of scoliosis over time. In some cases, there can be problems with breathing or discomfort which make surgery a necessity however in most cases scoliosis seems to stop progressing around the time of puberty and then the surgeon just needs to keep an eye on it.
I find one of the most helpful tests is to have a child bend forward at the waist, hanging the arms. If one arm appears to be longer or the thoracic spine (the area between the neck and the low back) seems to have a curvature the ribs will be more pronounced on the side of the curve. This is something that parents can do to monitor their child particularly if surgery is being considered. Unfortunately, there is no real exercise that can be done other than simply bracing with a corset brace to try to halt progression of the disease. If you have any doubts standing front – back x-rays should be performed to assess the degree of curvature. Most patients will have a slight curvature however anything above 10° is considered abnormal. Many patients will actually have a balanced curve with 10° in the thoracic spine balanced by 10° in the lumbar spine, the curves are generally in opposite directions. As I mentioned previously, when in doubt you should see a spine expert to help you diagnose and treat your child or young adult.