Scoliosis in Children

Learn how scoliosis may cause spinal deformity in kids

Scoliosis is a medical term taken from a Greek word meaning curvature. This disorder may develop during childhood, and it causes the spine to curve to the left or right side. This article explains key details about how this spinal deformity affects kids.

Scoliosis in Children is Complex but Rare
Scoliosis is the most common spinal deformity in school-age children. Approximately 3 million new cases of the condition are diagnosed in the United States each year, with most being adolescent idiopathic scoliosis. About 29,000 scoliosis surgeries are performed on adolescents annually in the United States.

There are six types of scoliosis that may affect children:

  1. Infantile idiopathic scoliosis is diagnosed in children ages 0 to 3.
  2. Juvenile idiopathic scoliosis is diagnosed in children ages 4 to 10.
  3. Adolescent idiopathic scoliosis is diagnosed in young people ages 11 to 18. It is the most common type of scoliosis.
  4. Congenital scoliosis occurs when the spine does not develop properly in the womb.
  5. Neuromuscular scoliosis is caused by brain, spinal cord, and muscular system disorders.
  6. Syndromic scoliosis develops as part of an underlying syndrome or disorder (eg, Marfan syndrome, muscular dystrophy).

Many types of scoliosis have idiopathic in their name—that means there’s no known cause.

In addition to the types noted above, your spine specialist may refer to your scoliosis as early-onset scoliosis—a term for scoliosis detected before 10 years of age.

Making a Diagnosis

School testing
For some children, it's a school nurse who first notices the scoliosis. In many schools in America, children are screened around fifth or sixth grade. The nurse generally uses the Adam's forward bend test, which is the most common physical screening test for scoliosis. During this test, the child bends forward at the waist with arms straight outward, positioned as though diving into a swimming pool. This usually reveals abnormalities, such as a rib hump or an incorrect shape of the back.

The Adam's forward bend test helps identify an unusual curve, but it can't tell you how severe the curve is. For that, you'll need to go to a doctor.

Adams forward bending test performed by a boy

Physical and neurological testing at your doctor’s office
A thorough medical and family history is obtained, and your doctor may use the following physical tests to see and measure the curve:

  • Adam's forward bend test: Like the school nurse, your doctor may also use this test to see the abnormal curve.
  • Plumb line test: This is a quick visual check to see if the spine is straight. In scoliosis, the plumb line will fall to the left or right of the spine instead of through the middle of the buttocks.
  • Scoliometer: If the doctor sees a rib hump, he or she can use a scoliometer to measure the size of the hump. It's a painless and noninvasive test.
  • Leg length: Legs are measured and compared to determine discrepancy.
  • Palpation: Your doctor will determine spinal abnormalities by feel. The ribs or lumbar muscles may feel more prominent on one side of the spine than the other.
  • Range of motion: Your doctor will measure the degree to which your child can perform movements of flexion, extension, lateral bending, and spinal rotation. The doctor also notes asymmetry.

In addition to the physical evaluation, your doctor performs a neurological examination. The purpose is to notate areas of numbness, tingling, weakness, and other neurological (eg, nerve) symptoms, which may include changes in bowel or bladder function.

Imaging exams
Your doctor will order imaging tests, such as x-rays, CT scans, and magnetic resonance imaging (MRI). The imaging studies give your doctor the opportunity to see exactly where the scoliosis affects the spine and the extent of the curve. These are some of the most important tests your doctor requires, as they are essential to planning a custom treatment plan.

Congenital Thoracic Curve

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Progressive Curve

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While MRI and CT scans may be used for some patients with suspected scoliosis, x-rays are the standard imaging test for identifying and monitoring the curve progression. To see the entire length of the spine, your child will stand during the x-ray. Two views are typically taken in x-rays for scoliosis to illustrate the full nature of the curve:

  • PA (posterior-anterior, or back to front) and lateral (side) x-rays.
  • Side bending AP (anterior-posterior, or front to back) x-rays assess spinal flexibility.

The x-ray results allow your doctor to measure and classify the curve by its size in terms of degrees.

  • Curves greater than 25-degrees to 30-degrees are significant.
  • Curves greater than 45-degrees to 50-degrees are severe.

While x-rays are key to illustrating the full nature of a scoliosis, they are also important in determining skeletal age and maturity. The progression of the curve may cease once your child reaches adulthood, so knowing how many growing years remain is essential to treatment planning.

  • To figure out the skeletal age, your doctor may order a wrist x-ray and compare that to a national standard. This will project how much growth is left and if the scoliosis is likely to progress.

X-rays are integral to diagnosis, but they’re also used to monitor curve progression and guide treatment decisions long after the initial diagnosis has been made. These additional x-rays have sparked radiation concerns—specifically exposure to breast tissue. To mitigate any ill effects of the scans, doctors limit the number of x-rays a patient receives each year and use lead shields to protect breast tissue.

Treatments for Children with Scoliosis
The severity and cause of the scoliosis are important factors that help determine the treatment plan for scoliosis. Three primary treatment options exist for kids with scoliosis: observation, spinal bracing, and spine surgery.

Sometimes, observation is the only treatment warranted. If more proactive treatment is necessary, spinal bracing is the standard way to help manage or prevent curve progression and improve deformity. You can read all about this approach in Spinal Bracing: A Treatment Option for Scoliosis in Children.

For advanced cases of scoliosis, your doctor may recommend a type of spine surgery called spinal fusion and instrumentation to treat the deformity.

Living with Scoliosis
Learning your child has scoliosis is a tough concept to wrap your mind around. You might feel worried that their condition will make them feel different from your peers, or you may wonder if your child be able to do the same activities other kids do. With an early diagnosis and a supportive network of family and friends, your child will find that scoliosis won’t come between him/her and the life they want to live.

Updated on: 02/24/17
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Causes of Scoliosis

There are several types of scoliosis, and some are idiopathic, meaning they don’t have an identified cause. Some scoliosis cases can be traced back to a disorder, syndrome, and even wear and tear on your spine.
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