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Scoliosis—Child

Definition

Scoliosis is an abnormal curvature of the spine, or backbone. Instead of a straight vertical line from the neck to the buttocks, the spine has a C- or S-shape.
Types of scoliosis include:
Scoliosis may also be described as infantile, juvenile, or adolescent based on the child's age at onset.
Scoliosis
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Causes

The different types of scoliosis have different causes.
Structural scoliosis—classified by the cause of the vertebral body defect:
Functional scoliosis may be caused by:
In some cases, scoliosis may be caused by damage to the vertebral body from:

Risk Factors

Factors that may increase your child's risk of developing syndromic scoliosis include having conditions that affect muscles and nerves, such as muscular dystrophy or cerebral palsy .
Idiopathic scoliosis is more common during the rapid growth phase of adolescence. Family history of scoliosis may also increase your child's chance of developing scoliosis.
Girls are more likely to have more severe curves. Scoliosis severity may also be influenced by:

Symptoms

In most cases, scoliosis doesn't have symptoms that can be felt. It is generally detected during a screening test, but may be noticed by the child or another person.
Some schools have scoliosis screening programs . If scoliosis is detected in school, you will be advised to follow-up with your doctor.
Scoliosis may cause:
More severe cases of scoliosis can lead to:

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. Scoliosis can be diagnosed on examination of the back and spine. The exam may include:
X-rays are usually done to:
Your child's doctor may recommend other tests to see if the scoliosis is caused by an underlying health condition.

Treatment

Functional scoliosis is reversible with treatment of the underlying condition.
Children with structural types of scoliosis will be referred to a spinal specialist if treatment is needed.
Scoliosis treatment depends on many factors. These include:
In general, children with a mild curve are treated with observation. This means your child will have regular follow-up exams and sometimes x-rays to see if the curve worsens. Frequency of follow-up appointments depends on age, stage of growth, and the severity of the curve. Physical therapy may be helpful to manage pain and optimize your child’s function.
Other treatment methods include:

Bracing

The goal of bracing is to prevent curves from getting worse. The doctor may recommend that your child wear a back brace if they are still growing and the curve is more than 20 degrees, but less than 40 degrees. Once growing stops, the need for more treatment will depend on the size of the curve and how it affects your child's appearance and function. Physiotherapy scoliosis specific exercises may also be advised.
Bracing may not be helpful in girls who have had their period for more than a year, in children who have attained full growth, or are within one year of full pelvic bone growth.
Bracing will feel uncomfortable at first. Children will need lots of support to wear the brace as prescribed, as well as encouragement to foster a positive body image.

Surgery

In severe cases where the curvature is greater than 40 degrees, your child's doctor may recommend surgery to lessen the curve or stop it from worsening if they are still growing. If they are done or almost done growing, it will be recommended for a curve greater than 50 degrees.
Surgery typically involves fusing the vertebrae of the spine together or the use of internal rods to decrease the curvature. Hospitalization can last 5-7 days. Recovery can take several months. Surgical techniques using stapling methods or implants, as well as other surgical techniques, are also available, but some are still experimental.

Prevention

There are no current guidelines for preventing scoliosis because the cause is usually unknown.

RESOURCES

Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

Scoliosis Research Society http://www.srs.org

CANADIAN RESOURCES

Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

Health Canada http://www.hc-sc.gc.ca

References

Adolescent idiopathic scoliosis: an overview. Hospital for Special Surgery website. Available at: https://www.hss.edu/conditions%5Fadolescent-idiopathic-scoliosis-overview.asp. Updated February 28, 2011. Accessed December 1, 2015.

Altaf F, Gibson A, et al. Adolescent idiopathic scoliosis. BMJ. 2013;346:f2508.

Idiopathic scoliosis in children and adolescents. Ortho Info—American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Updated March 2015. Accessed December 15, 2015.

Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews. 2015;6:CD006850.

Scoliosis. American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=44c972bb-9690-4505-99f2-0a4c6d1a41a4#.VnBY1L8TDOs. Accessed December 1, 2015.

Adolescent idiopathic scoliosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 8, 2015. Accessed December 15, 2015.

Scoliosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scoliosis/default.asp. Updated July 2013. Accessed December 15, 2015.

Scoliosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scoliosis/scoliosis%5Fff.asp. Updated November 2014. Accessed December 15, 2015.

4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.

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