Scoliosis in Children from AZ: Diagnosis and Management

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

For a parent, observing a deviation from the spine of her child can be worrying. We think of scoliosis, of future problems that may develop, in the eyes of others.

Rest assured, scoliosis is not always problematic in itself. And there are nowadays several treatment modalities allowing the management of scoliosis in children.

In the following article, we are going to cover everything you need to know about this condition, from its diagnosis to the different possible treatment options. 

Scoliosis, what is it exactly?

 

Scoliosis is a deviation of the spine in the 3 planes of space. Basically, one or more vertebrae are deviated in the frontal, sagittal, and horizontal plane. Vertebral rotation (torsion) in the horizontal plane is what mainly characterizes scoliosis.

Interesting fact about scoliosis: One of its particular characteristics is that it exclusively affects human beings. No need to look for a spinal deviation in your cat or dog! Our upright and bipodal posture could also be a prior factor in the development of scoliosis.

Scoliosis can affect any region of the spine, but it is predominant at the dorsal and lumbar level.

The curvature of the spine is measured in degrees via Cobb's angle (discussed in the section linked tomedical imaging). It is this angle that will determine the severity of the scoliosis. A scoliosis between 10-20 degrees is considered mild, while it is considered severe when it exceeds 30-60 degrees.

Let's not forget that scoliosis is often scalable, ie it can progress over time. For example, Marie, an 11-year-old girl, may have had 22 degrees of scoliosis that worsened by 10 degrees in 1 year to reach 32 degrees when she turned 12…

Consequences and symptoms

The consequences and symptoms of scoliosis are very varied, and depend on several factors such as the Cobb angle, the compensatory schemes developed, and the irritated structures. Among other things, scoliosis can cause:

Pain

Be careful, not all scoliosis is symptomatic. On the other hand, it is possible to observe spinal pain. This is also one of the reasons that lead patients to consult the doctor.

Appearance change

Scoliosis is associated with humpback. This is a deformation of the rib cage observable when the patient leans forward, a bit like a “lump in the back”. 

Functional limitations

Depending on the scoliosis, there may be a limitation of amplitudes in the spine that affects activities of daily living (such as certain movements, walking, etc.).

 

Neurological disorders

Considering the proximity of nerve roots and nerves on either side of the spine, it is easy to understand that a spinal deformity can irritate certain nerve structures. This can in particular cause sensory damage (neuropathic pain, numbness, electric shocks, tingling, etc.).

In more severe cases, scoliosis can affect motor skills and even locomotion by damage to motor nerves.

 

Respiratory problems

The deformation of the spine can cause problems with breathing (considering the proximity of the lungs and the heart).

More specifically, we can see a impact on vital capacity and/or expiratory volume peak per second (FEVXNUMX) measured by spirometry. Again, the degree of impairment depends on certain factors such as the Cobb angle.

Psychological impact

 Do not underestimate the impact that scoliosis can have on a psychological level, especially in children. Body image being different, the young person may present with anxiety, feel shame, suffer from depression, etc.

 

The scoliotic attitude, or "false" scoliosis

Postural scoliosis should not be confused with structural scoliosis (the “true” scoliosis). Also called false scoliosis, the scoliotic posture is not fixed or permanent.

For example, a parent might suspect scoliosis in their daughter after observing a “deformity” in the spine. On examination, the doctor may observe an inequality in the length of the legs responsible for this spinal deviation. By asking the child to lie on his back, we could then observe a correction of the deviation.

In this case, we would rather speak of a scoliotic attitude than of true scoliosis. The radiological examination can also confirm whether the scoliosis is structural (true) or false.

The causes of scoliosis

 

Let me guess, you think your child's scoliosis developed as a result of his "bad posture"…Fake ! 

The scoliosis mostly develop during growth of the spine (and therefore during childhood and adolescence). And no, it is not due to your child wearing a backpack either! Read on to learn about the main causes of scoliosis.

The main causes of scoliosis are congenital, syndromic or idiopathic:

La congenital cause results from a malformation of the spine at birth (such as the spina bifida). In addition, certain neuromuscular diseases or syndromes can cause curvature of the spine. We think for example of:

• Duchenne's disease
• Friedrich's ataxia
• cerebral palsy
• muscular dystrophy
• etc.

When at the idiopathic cause, imagine that it is the most frequent with nearly 80% of cases of scoliosis. Yes yes, this means that most of the time, we do not know where exactly the scoliosis comes from! Some scientists even talk about genetics as the main cause of scoliosis.

Other hypotheses refer to theinvolvement of hormones such as somatropin or melatonin in the development of scoliosis.

 

What to expect when consulting?

 

Obviously, a health professional, and more particularly the doctor, is the person of choice to consult if you notice any change in your child's spine.

Here are some details related to the evaluation and diagnosis of scoliosis:

Physical examination

 

Most often, the physician or qualified therapist will begin the consultation with a physical examination. He generally begins by observing the posture from the front, back and profile (sometimes using a plumb line).

What you have to understand is that a deviation of the spine can have an impact on several other joints, and cause multiple biomechanical alterations.

For example, one could then observe a shorter right leg, a higher iliac crest, a lower shoulder, rotating ribs, etc. These findings are often noted, but should not be systematically considered as a dysfunction of the human body. Indeed, it is able to compensate, and the tissues can adapt in order to avoid pain.

One of the findings indicative of scoliosis is the humpback. As a reminder, this is a deformation of the rib cage observable when the patient leans forward, a bit like a “lump in the back”. 

The doctor could finish with a skin, joint, neurological and respiratory examination. This clinical examination is essential not only to better appreciate the impact of scoliosis on the body and function, but also to measure certain parameters again in the future for the purpose of comparison.

Medical imaging

 

When he suspects scoliosis, the doctor can also refer his patient for medical imaging to confirm the diagnosis.

X-ray is the imaging of choice, and can measure Cobb's angle. This is the angle formed from the intersection of two straight lines tangential to each other at the upper plate of the vertebrate upper limit, the other to the lower plateau of the lower limit vertebra.

Depending on the Cobb angle, it can be determined whether the patient can benefit from surgery, or rather from conservative treatment. This measure will also be reassessed regularly as the child grows to assess the progression of his scoliosis, and the impact of the treatments attempted.

The other measurement evaluated by x-ray is the Risser's test. This examination is performed to assess the state of maturation of a child's skeleton. Basically, if growth has stopped, treatments such as corsets are less likely to prevent spinal deviations. On the contrary, if the child is in full growth period, it will be necessary to correct the deviation aggressively, and thus prevent the progression of scoliosis.

What treatments can help?

 

Observation

 

I am often asked what should be done to prevent the onset of scoliosis. Unfortunately, you will have understood that it is most often an idiopathic condition, which means that we do not know exactly its cause. For this reason, it is impossible for a professional to give preventive advice to avoid its appearance.

Note, however, that a early diagnosis generally allows better management, and significantly reduces the chances of aggravation of the condition in the future.

Indeed, the most aggressive period in the evolution of idiopathic scoliosis in adolescents coincides with puberty. Thus, it is recommended to keep an eye on your child's spine if you suffer from scoliosis yourself, or if it is a widespread condition in your family.

The main thing would be to see your doctor regularly (and early, ideally at prepubescent age). It is for this reason that many primary school workers make sure to regularly observe the posture of their students.

Some doctors will ask for follow-up x-rays to ensure the favorable evolution of the scoliosis (mainly in growing children).

On this subject, you are possibly worried about the harmful effects of x-rays on your child due to radiation. On the other hand, know that the doctor always weighs the beneficial effects and the risks related to any medical intervention. Thus, if he proposes medical imaging, it is because the benefits of controlling scoliosis over time outweigh the low risks of complications related to X-rays.

Likewise, the radiologist will always make sure to protect certain areas of the body in order to minimize the associated risks.

Physical activity

 

I often hear that young people with scoliosis should avoid sports. It's a myth. I would even say that it is an aberration!

Physical activity in general will soften the tissues, tone the muscles, improve cardiorespiratory capacity and release endorphins.

Admittedly, some asymmetrical sports such as golf or tennis could "fix" the body in a restricted pattern due to the repeated unidirectional movements. This is also the reason why many practitioners recommend swimming to individuals with scoliosis.

In any case, a healthcare professional will be able to adjust your sports practices so that you benefit from the beneficial effects of physical activity, while avoiding the aggravation of symptoms and restrictions related to your scoliosis.

 

Lumbar corset

 

The brace is often used in cases of relatively severe scoliosis. For example, we know that if the scoliosis exceeds 30 degrees at prepubescent age, the prognosis is limited, and the scoliosis has a good chance of progressing to significant angles.

Thus, the objective of the brace is to slow the progression of scoliosis, and ideally avoid surgery. I repeat. The brace will rarely correct the angle of the scoliosis, but rather prevent the scoliotic curvature from worsening.

Unfortunately, I too often meet parents convinced that the brace will completely cure their child's scoliosis, and necessarily disappointed a posteriori by comparing the scoliosis x-rays with the previous shots.

To know everything about braces in the presence of scoliosis (indication, types, benefits, risks, alternatives), consult the following article:

Scoliosis corset: What to remember?

Rehabilitation techniques

 

There are several therapists and techniques adapted to scoliosis used in rehabilitation. Often they are performed by physiotherapists (physiotherapists) or osteopaths. Among them, we find:

• the Mézière method
• the Schroth method
• global postural rehabilitation (RPG)
• etc.

All approaches have similar goals, namely restoring muscle and joint symmetry (through chain work and stabilization work), optimizing breathing, and improving body awareness.

Unfortunately, no therapist can perform miracles and correct significant spinal deformity (especially when the Cobb angle is high). On the other hand, it will be able to act on the level of pain and overall function.

So be sure to find a practitioner in your area who has experience with scoliosis, and whom you trust.

Psychology

 

Don't underestimate theimpact of body image impaired due to scoliosis. This “ineestheticism” can greatly affect affected individuals, and affect several spheres of their lives. A psychologist can treat the emotional aspect related to scoliosis.

 

Is surgery necessary?

This is a frequently asked question among individuals with scoliosis. Obviously, the answer to this question is very variable, and depends on several factors. The best person to consult for a definitive and adapted answer would be the orthopedic surgeon.

What should be remembered is that surgery is most often the last resort, mainly because it is a complex and major operation. This also implies that the scoliosis is significant (for example, with a Cobb angle exceeding 50 degrees).

IFinally, you must have tried other forms of treatment and noted a failure with this conservative approach (such as the corset or the physiotherapist). Similarly, surgery is most often used when the deformation caused by scoliosis becomes disabling, either functionally (pain and/or respiratory problems in everyday life) or aesthetically (significant deformation).

There are several types of surgeries possible depending on the scoliosis and the patient. These can last between 4 and 12 hours! Most often, they involve arthrodesis (fusion of vertebrae) and the placement of metal rods to straighten the column. The operation may also include bone grafting to stimulate bone healing.

Yes, surgery is the only way to correct spinal curvature caused by severe scoliosis. However, this comes with its own set of problems.

Although rare, post-operative complications such as infection or nerve irritation may ensue (considering the presence of nerve roots on either side of the spine). However, the most deleterious complication is that the column becomes permanently fixed. This increases the stiffness of the spine, and the compensatory work of the other structures (muscles, tendons, etc.) aimed at compensating for the reduction in mobility. After all, the back is made to move! This is also the reason why we must carefully weigh the pros and cons of surgery, and refer to a qualified surgeon who will help us make an informed choice.

 

Conclusion

 

So! I dare to hope that you are more familiar with the diagnosis of scoliosis. When we talk about this condition, many people have in mind a restrictive and problematic deformity of the spine. You now know that this is not always the case.

The human body isn't always perfectly symmetrical, and doesn't need to be either! A small deviation should not be taken for a disease requiring immediate treatment. On the other hand, other types of scoliosis lead to functional disorders and must be taken seriously. It is mainly the Cobb angle and the degree of bone maturation that will dictate the course of action to promote optimal management.

It is essential to treat scoliosis from a biopsychosocial point of view, in particular because it is multi-factorial and influences several aspects of the life of the affected person. The ideal is to join forces with a multidisciplinary team (including the doctor, the various therapists, the patient and his family).

Unity is strength!

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