Do you think your child could have a curve in his or her spine? Scoliosis, the medical term for an abnormal sideways curvature of the spine, is most common in children between the ages of 10 and 16. But it can also occur in younger children or adults.
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“When scoliosis curves, it rotates the ribs, so if you’re not sure, have your child bend forward,” says David Gurd, MD, Head of Pediatric Spinal Deformity Surgery at Cleveland Clinic. “If he or she has scoliosis, you’ll see an elevation where the scoliosis is turning the rib cage toward one side.”
Some other signs include:
- One shoulder higher than the other
- One shoulder blade sticking out farther than the other
- A lump or hump on one side of the back
- A slight leaning to one side
If you believe your child may have scoliosis, get an evaluation by your pediatrician or family physician, Dr. Gurd advises.
Will the curve get any bigger?
“The question we get asked most often with kids is, ‘Is the curve going to get any bigger?’” says Dr. Gurd. “The answer is that the more growing your child still has to do — and the larger the curve — the more likely it is to get worse.”
Doctors can detect childhood scoliosis, also known as pediatric or early-onset scoliosis, in infancy, childhood or adolescence.
Scoliosis in infants and young children
Infantile scoliosis occurs in newborns up to age 3, according to Dr. Gurd. But it is sometimes difficult to detect in infants.
“In some cases, the curve might get better,” he says.
“In very young infants, it can be hard to determine if they actually have a curve or if they just don’t have enough trunk strength yet to hold themselves upright. But by the time your infant is old enough to sit up and start walking, a real curve can become more obvious, especially if we’re seeing a progression on subsequent X-rays,” he says.
An early diagnosis of scoliosis may mean a child will have complications.
“Young children still have a lot of growing to do. So if your child already has a large curve at a young age, the spine will continue to twist and curve,” Dr. Gurd says. “The problem is that doesn’t leave enough space for the lungs to do their job, so your child can run into a lot of pulmonary or breathing problems.”
In young children, scoliosis treatment often begins with a padded plastic brace strapped on with Velcro® fasteners.
“Bracing stabilizes your child’s spine to hold it upright,” says Dr. Gurd. “Casting is sometimes also used to help move your child’s spine into a better position. In some cases, bracing or casting can improve the curve; other times it just delays the curve getting worse.”
Relieving pain at home
“Scoliosis is not typically associated with pain,” Dr. Gurd says. “However, around 33 percent of children with or without scoliosis have some sort of back pain.”
He says stretching and strengthening exercises benefit core muscles and help relieve pain. The Schroth method and yoga are helpful in managing scoliosis in some cases, he says.
Treating scoliosis with surgery
In many cases, surgery can correct problems with the spine. In children who are still growing, a “growing rod” is surgically attached to the spine to stabilize it. This allows the chest and spine to grow almost to maturity. The spine is then ready for permanent fusion.
“At one time, we had to do another surgery about every six months to elongate the connector as the child was growing,” says Dr. Gurd. “Now we insert one or two rods, called a MAGEC® [MAGnetic Expansion Control] rod(s). Then every three months, your child will return, and the rod(s) can be elongated magnetically without an additional surgery.”
In older children, fusion surgery can correct the curve. During fusion surgery, the surgeon places screws into the affected vertebrae. A short rod is then inserted into slots along the top of the screws. The surgeon gently moves the rods to correct the spine’s alignment, then bolts the hardware in place.
What to expect after surgery
Dr. Gurd says the hospital stay for “growing rod” surgery is around two to three days. A stay for fusion surgery is usually three days.
“In the early stages, pain is controlled with a PCA [patient-controlled analgesia] pump, so your child can hit a button when in pain and the machine will deliver a safe dosage of pain medication,” Dr. Gurd says. “Then your child will be weaned to oral pain medications, which is usually necessary for about five to seven days.”
Bracing is sometimes needed in the early days after “growing rod” surgery. However, fusion surgery immediately makes the spine straighter, so there is usually no need for bracing afterward.
“The surgery will permanently stiffen your child’s spine, but mobility and function are not usually affected,” Dr. Gurd says. “Most patients are able to return to sports and activities with good function and success,” he says. “However, they should avoid contact sports, such as football.”
MAGEC® is a registered trademark of Ellipse Technologies, Inc.