Dr. Frank Schwab being interviewed by FOX Health.

In children and adolescents, the most common type of scoliosis is called Idiopathic Scoliosis. As its name implies (idiopathic means that no specific or clear origin is identified) the cause of this deformity is not known but may be caused by a combination of factors (possibly hormonal, genetic, and neurologic). Idiopathic scoliosis is commonly divided into different categories depending upon the age at which the spinal deformity is first noted: infantile scoliosis (0-3 years), juvenile (4-10 years) and adolescent (11-maturity).

Adolescent Idiopathic Scoliosis

This is by far the most common type of scoliosis in children. It more commonly affects girls than boys. Progression of spinal curvature is related to numerous factors, most notably the age of the patient and the curve size. For example, a young girl that has not reached menarche (when she has her first period) is at much higher risk for scoliosis progression than a girl 2 years after onset of menses (having her period regularly). The degree of curvature is also important in that a 20 degree curve in a young girl is much less likely to develop into a severe curve than a 40 degree curve at the same age. In boys, growth can continue well beyond 13 years of age so curve progression is still quite possible at a later age than in girls. Once a child is skeletally mature (no further growth in height), the likelihood of an idiopathic scoliosis worsening is very unlikely unless the curve is around 50 degrees or greater.

There are many different type of curve patterns in idiopathic scoliosis. Most curves tend have a thoracic and a lumbar component. This means that there is one curve to the side in the upper part of the spine (rib cage area) and another one in the lower back. The two curves often balance each other out so that the head is still centered over the pelvis (although the shoulders may appear asymmetric). In some cases this does not occur, and marked imbalance may be present. If a curve appears to be very unusual in shape or rapidly progressive then a suspicion must be raised that the scoliosis is perhaps not idiopathic (possibly congenital, neuromuscular or other).

Treatment: Although severe curves carry a risk that lung and heart function may become affected, most mild and moderate curves lead rather to an aesthetic problem and rarely a true functional disability. In fact the most noticeable aspect of a scoliosis may be a rib hump on the back which is a result of spinal rotation in scoliosis and not only the lateral deviation of the spine. Because it is difficult to be certain which curves will progress and by how much, all curves in an adolescent patient must be very carefully evaluated and closely followed. The treatment must be individualized in every case. For very mild curves (generally 10-20 degrees) regular check-ups and X-rays may be all that is prescribed. For moderate curves, or those that are worsening over time, a brace may be prescribed (custom orthosis). Brace treatment may limit curve worsening in immature patients but does not permanently correct a curve and is not effective once growth has stopped. For severe curves (around 50 degrees or more), and those with clear and substantial progression, surgery is often considered. The optimal surgical treatment will depend upon the exact curve type and its location. In some cases the curve is corrected from the front although mostly a correction with a spinal fusion is performed through the back. New techniques such as endoscopic surgery can offer advantages in certain types of scoliotic curves: minimizing the size of incisions and blood loss as well as permitting a more rapid recovery.

Frequently Asked Questions

Juvenile Idiopathic Scoliosis

This is a scoliosis, which develops well before the age of puberty (4-10 years). The scoliosis commonly starts by the age of 6 with a very small curve, which can rapidly become quite significant long before skeletal maturation. For example, a 30 degree curve on a 6-year-old girl may continue to progress until the end of the growth spurt (18 months after the onset of menstruation). By that time it can be severe and lead to marked deformity. It has been shown that the application of a Milwaukee brace can improve the juvenile curves and reduce the possible need for surgical treatment. The worst results are seen in young children whose curves are greater than 30 degrees at the time of diagnosis. Surgical treatment with fusion and the use of spinal instrumentation may be necessary early on to slow or stop curve progression. In some cases surgical techniques of curve correction without fusion have been applied. This may give some continued growth of the spine until a later fusion procedure.

Infantile Scoliosis

This is a spinal curvature, which can develop even before a baby has ever walked (0-3 years). It is very rare but when it happens may lead to very severe deformity of the spine. This type of scoliosis is not very frequent in North America where babies are nursed in various positions, and part time prone positioning may reduce the incidence of this deformity. When the scoliotic curve is more than 30 degrees the application of a brace may correct the deformity and prevent the curve from progressing. Many cases of infantile scoliosis resolve completely without any long-term effects on the infant.

In severe and progressive cases of scoliosis, surgical treatment with fusion and the use of spinal instrumentation may be necessary early on to slow or stop curve progression. In some cases surgical techniques of curve correction without fusion have been applied. This may give some continued growth of the spine until a later fusion procedure. Due to the complex nature of infantile scoliosis, several surgeries over a span of years may be necessary in order to control the deformity and maintain spinal balance.

Frequently Asked Questions