When Your Child Has Scoliosis: Symptoms & Treatments

As a parent, you want answers to your questions about scoliosis and how it can affect your child's development. Here’s what you need to know about scoliosis symptoms and how this spine condition is treated.

What Is Scoliosis?

Scoliosis is a sideways spine curve that can affect a person's posture and eventually lead to back pain.

Human spines are naturally curved and flexible so that you can bend, twist, reach and more.

"The normal curve is kind of an S shape that we all have. Our spines are not actually straight," said Wajeeh Bakhsh, MD, an orthopedic spine surgeon at Franciscan Health Michigan City. Even though we like to think of having a straight posture, our spines aren't straight, which allows us to stand up straight. And a scoliosis is when there's a change to that. It's not only a curve, but it also includes a twist or rotational component as well."

In some people, the natural curve of the spine doesn't develop properly and the spine takes on an "S" or "C" shape. This condition is known as scoliosis and it affects about 6 million Americans, according to the National Scoliosis Foundation. Scoliosis affects 2 to 3 percent of kids in the United States.

What Are Scoliosis Symptoms?

Children don’t usually complain about back pain with scoliosis. Scoliosis symptoms include a spine curving abnormally to the side, one shoulder appearing higher than the other, or the pelvis seeming out of alignment.

Other signs of scoliosis can include:

• Back and leg pain
• Muscle weakness
• Complications standing straight

Other symptoms can include:

• Uneven pelvis, waist, shoulders and leg length
• Elevated hips
• Leaning
• Changes in skin appearance along the back and spine
• Height loss

Scoliosis is usually diagnosed between the ages of 10 and 15, according to the scoliosis foundation. If you have a family member who's had scoliosis, your odds of developing the disorder increase to one in five, instead of the usual one in 50, according to the American Academy of Orthopaedic Surgeons. 

"The symptoms are really dependent on the location of the curve and how severe it is," Dr. Bakhsh said. "So if it's a small curve and it's in a part of the spine where you can compensate and it doesn't make too much of a difference in terms of your function, you might never notice. Generally speaking, the more mild it is, the less symptomatic it is. If it is a severe curve, then it can cause some significant deformity where you notice.

"While scoliosis isn't a dangerous or life-threatening condition, the symptoms can sometimes be uncomfortable. And for teens, having scoliosis can be damaging to self-esteem."

More advanced scoliosis can cause physical symptoms impacting a person's quality of life.

"With more advanced scoliosis, physical complications can go as far as affecting the ability of the lungs to expand if the rib cage becomes kind of constricted," Dr. Bakhsh said. "That's when we really have to get involved surgically to help straighten out the spine to make sure that you can address some of these complications."

What Causes Scoliosis?

In most cases, the cause of scoliosis isn't known. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains idiopathic scoliosis is the most common type and the cause is unknown; however, a combination of genes, hormones and changes in cell structure could be the cause.

However, there are two known causes of scoliosis: congenital and neuromuscular, according to the U.S. National Institutes of Health. 

In congenital scoliosis, a problem occurs in the womb when the spine is forming that causes it to develop with a curve.

"There's also neuromuscular disorders where the spinal cord and the body's nerves aren't developing the right way and that can lead to a curve to the spine if there's say, a component of a vertebrae that doesn't develop, so there are some congenital or neuromuscular scoliosis conditions that are out there," Dr. Bakhsh said.

In neuromuscular scoliosis, the curve may be caused by poor muscle control or weakness from diseases such as cerebral palsy or muscular dystrophy. The muscles simply can't keep the spine in proper alignment. 

Later in life, scoliosis may develop as a result of osteoporosis.

"There's a version of it that happens with age we call it degenerative scoliosis because as the spines wear out, sometimes it can wear out more to one side than the other and that pulls you into a tilt going that way and that can kind of result in a curve," Dr. Bakhsh said. 

Is Scoliosis Genetic?

Researchers continue to study whether there’s a genetic component to AIS. According to the Scoliosis Research Society, “Approximately 30% of AIS patients have some family history of scoliosis, which would indicate a genetic connection.”

How Is Scoliosis Diagnosed?

Many children are unaware they have scoliosis. It's often discovered during a routine physical exam or at a scoliosis screening at school.

"A conversation about scoliosis happens often during an annual visit," said board-certified pediatrician Chantal Walker, MD, a Franciscan Physician Network doctor in northwest Indiana.

Injuries, genetics and tumors along the spine can play a role in forming scoliosis.

"We start screening for conditions like scoliosis at eight or nine years old through adolescence," Dr. Walker said. "If the kids aren't coming to the doctor, they won't have that screen. With a curve in your back that's more than 15 or 16 degrees, it's essential to follow up with an orthopedic doctor."

The diagnosis can usually be made from a physical exam, but most of the time, a spinal X-ray will also be done to confirm the diagnosis and more accurately assess the degree of the curve. Knowing the exact degree of the curve is important because it helps to guide treatment decisions.

How Is Scoliosis Treated?

Treatment options for scoliosis include:

Observation and monitoring

For patients with mild scoliosis, especially if they’re still growing. Monitoring during growth spurts is important and includes regular doctor visits and imaging.

Bracing and casting

Your doctor may recommend a scoliosis brace or a cast for moderate scoliosis in children still growing. This can slow or stop the curve from progressing. The brace is customized and worn for a prescribed length of time each day.

"We have gotten better with our bracing technology to help prevent these curves from getting bad enough where we need to operate on them," Dr. Bakhsh said. 

"The emotional battle is sometimes that it's sometimes more important than the physical one," he continued. "Bracing, for example, is such a challenge because kids can be mean and no one wants to be the kid wearing a brace, like a funky brace that goes all the way up your body and gets in the way when you're changing for gym class and all that kind of stuff.  The important thing is having a good family support system; we have counseling available for these patients and understanding from the patient themselves, bracing and like treatment of these scoliosis conditions can be successfully accomplished. It just requires a little bit more of a kind of holistic touch than just saying, 'Hey, here's a brace, wear it.'"

Physical therapy

One physical therapy regimen is the Schroth method, which includes breathing exercises, physical movement and other forms of physical therapy. Maintaining activity and mobility are important for scoliosis self-care.

Scoliosis surgery 

Scoliosis surgery is considered for children with severe scoliosis who have passed their growth spurt and haven’t responded to other forms of treatment. Spinal fusion is the most common surgery.

"When there are curves that will need surgery, sometimes if we catch them early enough, in order to avoid doing the big surgery, which is fusion with screws and rods, sometimes we can use tethering to help anchor the spine and guide it to grow back into the right shape," Dr. Bakhsh said. "When curves are smaller, we can better predict how they'll behave, so that's why we try to get involved as soon as possible.

"The gold standard of treatment is still a big surgery, and that's the way to kind of correct the spine and hold it in place. It's the most definitive way to treat it, but we have exploring and developing new ways to address especially the smaller curves."

Long-term Outcomes Of Scoliosis Treatment

"Patients with mild scoliosis, in general, they do very well," Dr. Bakhsh said. "They won't have any long term restrictions or not be able to play football or anything like that. If it's a bad enough scoliosis where we need to get involved with bracing early on and some activity modification later, patients can lead totally full lives.

"The most essential thing, especially with these scoliosis curves, if they start having a little bit of a cosmetic change, is we coach and really reinforce self-love and self- confidence. To be happy with your body. Some of the more serious cases in scoliosis that require surgery, you know, as long as patients are partnered with their surgeons, they'll end up doing well. It can just take a year or so to really complete their recovery.

"Overall, it's not a condition to be afraid of depending on the curve. There are some more invasive things that might need to happen. But don't be afraid of the diagnosis; treat it early. And it's always worth having a conversation with your spine surgeon."

HealthDay News contributed information to this article.