5 Causes Of Scoliosis In Children, Symptoms And Treatment

Scoliosis in children causes the spine to curve at or more than 10° angle. Usually, the spine is straight, and the children with scoliosis can have a C- or S-shaped spine, making the child appear as leaning to the side. According to the Children’s Hospital of Philadelphia, more than 100,000 children in the US are diagnosed with scoliosis (1). It can occur at any age.

The curving of the spine may usually begin as early as the age of five years when there is rapid growth, and the curving may continue until adolescence. The curvature may reduce after the skeletal system attains maturity or maximum growth. However, a few people may have scoliosis throughout adulthood (2). Early diagnosis and interventions help to prevent complications.

Read one to know the causes, types, and available treatment modalities for scoliosis in children.

Causes And Types Of Scoliosis

There are many classifications for scoliosis. Some are based on the age of the child during the onset of the condition, and others are based on the cause. It is essential to understand the types to identify it early on. Also, the diagnosis of scoliosis during birth or early childhood is rare, and the majority of children are diagnosed between the ages of ten and 15 years (1).

Based on the cause, scoliosis is classified into four broad categories.

1. Congenital scoliosis: This type may be caused by fetal abnormalities of the vertebrae, genetic predisposition, maternal factors, or environmental factors, such as exposure to increased pollution. It can be part of a syndrome, and would need expert examination and investigation. The curvature of the spine varies from child to child, making it difficult for evaluation. Some signs of congenital scoliosis include patches on the overlying skin and a shortened neck or trunk. Children with this type of scoliosis may also have renal or bladder abnormalities and congenital heart defects (2)

2. Neuromuscular scoliosis: The spine may also curve due to specific abnormalities of the nervous or musculoskeletal system, such as cerebral palsy, Marfan syndrome, or neurofibromatosis. In this type of scoliosis, the curving of the spine is likely to continue and progress into adulthood. Although children may not experience any pain, they might have poor balance and coordination of the trunk, head, and neck, seating issues, and hygiene challenges (3)

3. Thoracogenic scoliosis: In this type, the curvature of the spine could result from a disruption of the chest wall post-surgery or due to a disease. It is found that children who had cardiothoracic surgery are at a higher risk of developing thoracogenic scoliosis. The curvature might start to appear shortly after the operation or many years later, especially during the adolescent growth spurt (2)

4. Idiopathic scoliosis: The cause of this type is unknown, and it could likely be due to a combination of genetics, hormones, or environmental factors.

Idiopathic scoliosis is further categorized into:

• Infantile idiopathic scoliosis, which is seen from birth to three years

• Juvenile idiopathic scoliosis, which is seen in children from three to eight years

• Adolescent idiopathic scoliosis, which appears during the adolescent growth spurt, from ten to 15 years.

Congenital, infantile, and juvenile scoliosis come under early-onset scoliosis (4). This condition is characterized by tilted shoulders, uneven waistline, and the appearance of the body leaning to one side (5).

Infections and bone and spinal tumors can also cause scoliosis in children (6).

Symptoms Of Scoliosis In Children

Some symptoms may be specific to the type of scoliosis. Here are some common symptoms.

• Uneven shoulders (one shoulder blade protrudes and appears tilted)

• Ribs appear prominent on one side

• Uneven waistline

• Hips of varying heights

• Appearance of leaning to one side

• Backache and lower back pain

• Weakness and tiredness after sitting or standing for a long time

• Curved spine

• Breathing problems (in case of severe scoliosis) (7)

What Are The Risk Factors Of Scoliosis In Children?

Scoliosis can be caused by conditions such as muscular dystrophy or cerebral palsy. However, the cause is mostly unknown.

What Are The Complications Of Scoliosis In Children?

Scoliosis might interfere with the well-being of the child. The long-term complications depend on the intensity of the curvature. Children with small and moderate curvature may experience slight back pain, and leg pain, whereas children with extreme curves may have respiratory problems.

A child with scoliosis may also face a few general complications.

• It may inhibit their ability to perform day-to-day activities.

• It may affect the self-esteem and confidence of the child (4).

It is important to diagnose and treat scoliosis early on. The next section covers the diagnosis of scoliosis in children.

Diagnosis Of Scoliosis

The first diagnostic test for scoliosis is a physical examination. The doctor examines the spine and back of the child to check for curvatures. Examination of posture and spinal curvature may also help in determining scoliosis. The doctor might also enquire about the medical history of the child.

The forward-bending test is helpful in determining scoliosis, which involves the following steps.

1. The child should stand with the feet together and parallel.

2. The palms should be placed together with the arms kept straight.

3. The child would be asked to bend forward with the fingertips pointing between the big toes.

4. The doctor would then examine the shape of the spine using a scoliometer.

If one side of the back is one centimeter higher than the other side, it might be scoliosis (7)

Your doctor might also prescribe an X-ray, MRI, or CT scan of the spine to determine if there is an underlying condition (7).

Next, let us look at the treatment options available for scoliosis.

Treatment For Scoliosis

In some children, early-onset scoliosis may not require treatment, as the condition may not worsen and might resolve on its own. However, frequent visits to the doctor are recommended to keep the spine curvature under observation.

Treatment is required for scoliosis that is progressive. Also, the treatment for scoliosis depends on the type and the magnitude of the spinal curvature.

Here are a few treatment options for scoliosis. Each treatment has its own advantages and disadvantages, which is why it is best to talk to your doctor before going for any treatment option.

Non-surgical treatments:Your doctor is the right person to understand your child’s condition and prescribe the best treatments available. The following non-surgical treatments are often prescribed in case of mild scoliosis (1).

• Observation: This is the treatment if the spinal curvature is mild (with curvature <25° for growing children, and <50°for children who are done with the growth stage). The doctor may suggest regular follow-ups and perform X-rays to check if the curvature has worsened. The frequency of the follow-ups depends on the child’s age, stage of growth, and the spine’s curving. During this time, physical therapy might help ease the pain and help your child function normally.

• Bracing: Spinal bracing is prescribed when the degree of curvature is between 25° and 40°. However, it is not recommended for children who have completed the growth phase, girls who have had their period for more than a year, and infants. The main aim of wearing a brace is to restrict the curvature from getting worse. A back brace might be given, which needs to be worn daily. Initially, children might feel uncomfortable wearing the brace, so the parents need to support them mentally and tell them the importance of wearing it. It should be noted that bracing does not give a permanent solution to scoliosis; it only stops the spine from curving further. A child on a brace might require surgical intervention for additional correction.

• Casting: This is a treatment method prescribed for younger children with significant curvature. Spinal casting may have a higher likelihood of improving scoliosis in children aged less than five years. The spinal cast is applied under general anesthesia and needs to be replaced every three to four months. However, casting might cause complications, such as skin erosions, constipation, or respiratory illnesses. So, caution is required while using it.

Surgical treatments: Surgical treatments are prescribed when conservative treatments fail to stop the spinal curving or in cases of breathing difficulties due to severe scoliosis (2)

• Posterior spinal fusion: (PSF) is the procedure that is recommended for children aged ten years and above and with a 50° or more curvature. In this method, dual rods are used to correct and prevent the curvature of the spine. In the case of children below ten years, growing rods are used. Post-surgery, your child might need to stay in the hospital for five to seven days, and it might take up to six months to recover. During recovery, you can seek physiotherapy to help your child walk and do everyday activities.

• Another surgical method is the Vertical Expandable Prosthetic Titanium Rib (VEPTR). This is an advanced treatment for children whose scoliosis has progressed into Thoracic Insufficiency Syndrome. In this condition, there would be severe deformities in the chest, spine, and ribs, which prevent normal breathing (8) (9).

Other modern techniques, such as stapling and vertebral body tethering, are also available but are in the experimental stage (2).

Home Care For Scoliosis

If your child is diagnosed with scoliosis, you can give them some home care treatments, along with the prescribed treatment, to help relieve the symptoms. However, as most of these treatments do not have any scientific backing, it is best to consult your doctor before trying them on your child.

Exercises are one of the best home care treatments available for scoliosis. Here are a few exercises that can be done before physical therapy. These do not offer any correction to the curving but might help in improving spinal mobility and stability.

• Pelvic tilts: Ask your child to lay on the back with the knees bent and feet flat on the floor. Next, ask them to flatten the back by tightening the stomach muscles and buttocks. Tell them to hold it for five seconds. Repeat it ten times.

• Cat-camel: Instruct your child to lie on the floor on all fours and tighten the abdominal muscles while keeping the head straight. Ask the child to take a deep breath in and lift the lower rib cage. As your child breathes out, ask them to lower the chest, look slightly upwards, and return to the starting position.

• Single leg balance: Ask your child to bend one knee while standing on one foot. You can ask them to stretch their hands to maintain balance. Repeat this five times (10).

Other home care steps include massage, stretches, and a nutritional diet. You can also use a memory foam mattress after consulting with your doctor. If the pain becomes unbearable, your doctor might prescribe some over-the-counter pain medications.

References

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Dr. Elna GibsonMBChB, MMed, Paeds

 

Dr. Elna Gibson is a general pediatrician. She did her MBChB and specialization as a pediatrician in South Africa at the University of Pretoria. She obtained MMed Pediatrics (masters) with distinction in 1993.As a young specialist, Dr.

Read full bio of Dr. Elna Gibson