Scoliosis In Children

GENERAL INFORMATION:

What is scoliosis? Scoliosis (sko-le-O-sis) is an abnormal curving of the spine. Normally, the spine is made up of bones that are like blocks placed on top of each other. The spine should be straight when seen from the back and a mirror-image letter 'S' from the side. The spine protects the spinal cord, and nerves coming to and from the spinal cord pass through the spine. The bones in the upper spine are connected to the ribs and help the ribs move when breathing. With scoliosis, the bones are not properly placed on top of the other causing the spine to curve sideways. Scoliosis may worsen slowly, quickly, or not at all. The abnormal curving in the spine may limit chest movement and cause lung or heart problems. Scoliosis in children can develop at any age but often starts during adolescence.

What causes scoliosis? In most cases, the exact cause of scoliosis is not known, especially if the spine was straight before. Idiopathic (unknown cause) scoliosis may affect children during their early, childhood, or late years. Scoliosis that occurs anytime from birth up to three years of age is called infantile scoliosis. If it starts between 3 and 10 years of age, it is called juvenile scoliosis. Scoliosis occurring at more than 10 years of age is called adolescent scoliosis. Other possible causes may be any of the following:

• Congenital: A birth defect in your child's back bones may cause scoliosis. The bones may have formed differently or incompletely, such that only half of the bone is present. Sometimes, the back bones or ribs are abnormally joined together. Instead of dividing into the normal small bones, a large block of bone is formed in the spine.
  
  
• Genetic: Your child may have scoliosis if someone else in your family had it also. Children having both parents with scoliosis may be at a higher risk of having scoliosis.
  
  
• Trauma: This may include fractures (broken bones), radiation, or surgery involving the spine.
  
  
• Other health conditions: Scoliosis may occur as a part or complication of another health condition. This may include diseases causing problems in muscle control or activity, such as polio, cerebral palsy, and muscular dystrophy. Ehlers-Danlos, Marfan syndrome, and osteogenesis imperfecta (brittle bone disease) may also cause scoliosis.

What are the signs and symptoms of scoliosis? Your child may have any of the following:

• Leaning to one side when standing, sitting, or walking.
  
  
• Shoulder blades, ribs, or hips that stick out more on one side than the other.
  
  
• Shoulder or waist that is lower on one side than the other.
  
  
• Sunken chest, rounded shoulders, and swayback.
  
  
• Trouble breathing or back pain if scoliosis is severe.

How is scoliosis diagnosed? Your child's caregiver may need to have a complete health history, including information about his growth and development. Past diseases or surgery, and diseases in your family are also important information. The caregiver may ask your child to bend forward, which may help show any deformities on his back. Your child's shoulders, hips, legs, and ribs may also be checked. How well your child moves and feels things may also be tested. Your child may also need the following tests:

• X-rays: Several x-ray pictures may be taken of your child's spine, including views taken from the back and sides. Your child's caregiver will carefully look at the x-rays to check the curve or shape of the spine. Other problems, such as broken, incomplete, or fused bones may also be seen. Your child's caregiver may also check if your child's bones are still growing.
  
  
• CT scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's bones, muscles, brain, body organs, and blood vessels. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if your child is allergic to shellfish, or has other allergies or medical conditions.
  
  
• MRI: This test is called magnetic resonance imaging. During the MRI, 3-D (three-dimensional) pictures are taken of your child's body. An MRI may be used to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his MRI. Never enter the MRI room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.

How is scoliosis treated? Treatment of scoliosis aims to correct or control the curving of the spine and prevent further problems. Treatment may depend on when your child's back began to curve and which bones are affected. The presence of symptoms and how severe the condition is will also be important. The cause of the scoliosis and how much your child's bones will still grow are also considered. Your child may have any of the following:

• Watchful waiting: If the curve is mild or his bones are almost completely grown, watchful waiting may be all that is needed. Your child's caregiver may want your child to have regular checkups to see if his scoliosis is improving.
  
  
• Cast or brace: Your child may need to wear a cast or back brace. This may help keep his spine from curving or stop the curving from getting worse. Most braces are light and small and may be worn under clothes. Sometimes, a cast is used first and replaced with a brace after a few months. The brace may be adjusted as your child grows.
  
  
• Surgery: Surgery may be done if the curve in the spine is very bad and a back brace does not stop help. Your child may have surgery to join bones together along the curve. Rods, screws, or wires may be put in the spine to make it straight.
  
  
• Other therapies: Other treatments may be used to help your child's scoliosis. Exercises may help improve his health, including his heart and lungs. Biofeedback therapy may teach your child correct his posture. Ask your child's caregiver for more information on other therapies as treatment of scoliosis.

Where can I find more information? Having a child with scoliosis may be hard for you and your family. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village, IL 60007-1098
  Phone: 1-847-434-4000
  Web Address: http://www.aap.org
  

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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