Understanding Scoliosis
As a parent, learning that your child has scoliosis can be overwhelming. The diagnosis, treatment options, and long-term implications may feel like a lot to process, especially when it involves making important decisions regarding your child’s health and well-being. However, with early detection, proper treatment, and consistent management, children with scoliosis can live active, healthy lives.
What is Scoliosis?
Scoliosis is a condition that causes the spine to curve sideways, often in a "C" or "S" shape. Although it can affect people of all ages, it is most commonly diagnosed in children and adolescents during their growth spurts. Adolescent Idiopathic Scoliosis (AIS), the most common type, typically affects children aged 10-18, with girls being more likely to develop severe scoliosis than boys.
The curvature can vary in severity, and not all cases of scoliosis require the same treatment. It's important to understand the diagnosis process and the available treatment options to ensure that your child receives the most appropriate care.
Diagnosis of Scoliosis
Scoliosis is often identified during routine check-ups or school screening programs. If a physician suspects scoliosis, they will begin by reviewing your child's medical and family history. They may ask about any other health conditions that could be contributing to the curvature of the spine.
A physical examination follows, where the doctor will assess your child’s posture, shoulder alignment, and rib cage symmetry. For example, the physician may ask your child to bend forward while looking for any visible asymmetry in the trunk or rib cage, which is a common sign of scoliosis.
The definitive diagnosis of scoliosis is made through x-rays. This imaging test provides a clear view of the spine, allowing the doctor to measure the degree of curvature and evaluate its severity. The degree of curvature is crucial in determining the treatment options and deciding whether intervention is necessary.
Treatment Options for Scoliosis
Once diagnosed, treatment for scoliosis will depend on the severity of the curve, the age of your child, and whether your child is still growing. The goal of treatment is to prevent the curve from worsening, reduce pain, and improve posture and function. A good patient-parent-physician relationship is key, as you will be seeing your physician regularly. Physical Medicine and Rehabilitation (PM&R) physicians are excellent at managing scoliosis, as they can quarterback care between your physical therapist, orthotist, and scoliosis surgeon as needed, ensuring coordinated and comprehensive treatment.
Observation
For mild scoliosis curves (less than 20 degrees), doctors may choose to monitor the condition without intervention. Your child will be scheduled for regular check-ups, and the doctor will use x-rays to track the progression of the curve. Observation is often recommended for children who are still growing, as their spines may change with further growth.
Bracing
For moderate curves (between 20 and 45 degrees) in growing children, bracing is often recommended. Braces are designed to prevent the curve from getting worse as your child continues to grow. They are most effective when worn as directed and can help avoid the need for surgery.
Braces must be worn consistently, typically for 16-23 hours per day. A custom-fitted brace can help slow the progression of the curve and improve alignment. After growth is complete, the brace is usually no longer needed.
Surgery
Scoliosis surgery is typically reserved for severe cases of scoliosis (greater than 45 degrees) or if the curve continues to worsen despite bracing. The most common surgical procedure for scoliosis is spinal fusion, which involves joining two or more vertebrae in the spine to straighten the curve. The surgery may involve the use of metal rods, screws, or other hardware to keep the spine stable during healing.
While surgery is highly effective in treating severe scoliosis, it is not without risks. Parents should discuss the benefits and risks of surgery with the surgeon to make an informed decision about the best course of action for their child.
Physical Therapy
In addition to bracing or surgery, physical therapy may be recommended to strengthen the muscles supporting the spine. Physical therapists can design specific exercises to help improve posture, flexibility, and muscle strength.
Who Treats Scoliosis?
Several healthcare professionals may be involved in the treatment of scoliosis:
Pediatricians: Play an important role in detecting scoliosis during routine exams and referring families to specialists.
Physiatrists: A physiatrist is a Physical Medicine and Rehabilitation (PM&R) physician specialist, like Dr. Amir Mahajer, who has fellowship training in nonoperative spine care and is an expert in managing nonoperative scoliosis. Physiatrists work closely with spine surgeons and can provide comprehensive care for scoliosis, often focusing on rehabilitation, pain management, and improving function.
Physical Therapists: The Schroth Method is a physical therapy approach specifically designed to manage scoliosis and kyphosis. This method helps to improve posture, correct spinal deformities, and reduce pain by using specific exercises tailored to the curve of the spine.
Orthotists: Design and fit braces to help manage scoliosis. They work closely with other specialists to ensure the brace fits properly and provides the necessary corrective forces.
Spine Surgeons: These specialists are either orthopedic surgeons or neurosurgeons, with some focusing specifically on scoliosis surgery. Spine surgeons can assess the severity of the condition and recommend surgical interventions when necessary. It’s important to ensure that the surgeon you choose specializes in scoliosis, as this will ensure that your child receives the best care tailored to their needs.
Living with Scoliosis
Coping with scoliosis, particularly when it involves wearing a brace, can be challenging for children and teens. It’s essential for parents to provide emotional support, as many children feel self-conscious or frustrated with the treatment. Here are a few tips to help your child manage:
Encourage Physical Activity: Regular exercise can help maintain overall health and strengthen muscles, which may prevent the curve from worsening. Consult with your child's doctor about which activities are safe.
Brace Compliance: If your child wears a brace, they may feel self-conscious. It’s important to remind them that wearing the brace as directed can help avoid surgery and improve their long-term health.
Support Groups: Consider joining scoliosis support groups for both parents and children. These groups can provide encouragement and useful information on managing the condition.
Advances in Scoliosis Diagnosis and Treatment
Recent advances in imaging and treatment technologies have improved the management of scoliosis. EOS® stereoradiography is a low-dose radiographic technique that provides 3D images of the spine with significantly reduced radiation exposure compared to traditional x-rays. It's important to stay informed about new treatment options and consult with healthcare professionals who specialize in scoliosis care to ensure the best outcome for your child.
Conclusion
While the diagnosis of scoliosis can feel daunting, it’s important to remember that there are effective treatments available to manage the condition. With early detection, appropriate monitoring, and a tailored treatment plan, children with scoliosis can lead active, healthy lives. Regular visits to a healthcare provider, wearing a brace if recommended, and maintaining an active lifestyle are key components of managing scoliosis and preventing further complications.
If you have any concerns or questions about your child's scoliosis diagnosis or treatment plan, don’t hesitate to seek a second opinion or consult a specialist. With the right care and support, your child can thrive despite their diagnosis.
