Scoliosis Screening: What Are We Looking For?

What is scoliosis?
To understand what scoliosis is, we need to know what a healthy spine looks like (Figure 1). When viewed from the front or back, the spine should look straight from the neck to the buttocks. When viewed from the side, a healthy spine should have a small outward curve in the upper back and a slight inward curve in the lower back. These natural curves position the head over the pelvis and help the spine work as a shock absorber to distribute mechanical stress during movement.

Figure 1.

The spine of a person with scoliosis however, curves to the left or right making the spine look S- or C-shaped (Figure 2). The curves of scoliosis are most easily seen when the patient bends forward. Abnormal curves can interfere with the spine's ability to function properly and if left untreated, can become worse.

Figure 2.

What causes scoliosis?
While scoliosis can have many causes including birth defects, neuromuscular disorders, connective tissue abnormalities, or injuries to the spine, the most common cause is termed "idiopathic," which means the exact cause is unknown. Idiopathic scoliosis most commonly affects young people ages 10-16 and is termed Adolescent Idiopathic Scoliosis, or AIS. And while good posture and avoiding carrying heavy loads (such as backpacks) is important for good spinal health, they do not impact the development of scoliosis.

Why screen for scoliosis?
Because scoliosis often begins in childhood during times of rapid growth, it is recommended that children be screened for scoliosis by their primary care physicians at their yearly checkups. In some communities, school nurses are able to conduct comprehensive scoliosis screening programs in the schools. If scoliosis is suspected, a simple x-ray of the spine can confirm if an abnormal curve is present. Early detection is key to stopping or slowing the progression of abnormal spinal curves.

How is scoliosis treated?
Spinal curves are measured in degrees. Curves that measure 25º or less in a patient that is still growing are not considered severe. For these patients, regular monitoring of the spine (every 4-6 months) by a spine specialist is all that is needed to ensure the curves are not progressing. Curves that progress rapidly or are over 30º usually require treatment in the skeleteally immature child.

The most common treatment for scoliosis is observation in which the patient is watched for any increase in the curvature. Bracing may be indicated if progression of the scoliosis is noted. Wearing a back brace for a length of time during periods of growth (such as during puberty) can help slow or stop the curves from progressing. This is important because if left untreated, scoliosis can cause a variety of problems such as:

• A difference in shoulder height
• Muscular prominence on one side of the back
• Breathing problems
• Heart problems

Severe curves or curves that progress even after the use of a back brace may require surgery. The most common surgical procedure to treat scoliosis is a spinal fusion. In this surgical procedure two or more vertebrae are fused together in order to correct abnormal curves and to stabilize and strengthen the spine. In many fusion surgeries, special implants such as screws, rods, wires, or cages are used along with bone growth materials to help facilitate successful fusion. In addition, thanks to recent advances in surgical technology, some patients can have this procedure done using minimally invasive techniques. These techniques are quicker, require smaller incisions, and may have faster recovery times for the patient.

What you can do?
Because idiopathic scoliosis has no know cause, it is impossible to completely prevent it from occurring. However, regular checkups during childhood are an important way to monitor a child's spinal health and allow for early detection and treatment if problems arise. Of course, regular exercise, eating a balanced diet, and not smoking are also great ways to keep the spine and the entire body healthy and strong.

If you are concerned about your child's spine, talk to your physician. Having your child screened for scoliosis is quick and painless and can prevent future health problems from happening.