What is pediatric scoliosis?
Pediatric scoliosis is a condition in which a child’s spine abnormally curves sideways or rotates. Scoliosis can range from mild to severe. People with mild scoliosis may only need to be seen by their doctor on a regular basis. Those with more severe cases may need braces or surgery.
What are the symptoms of pediatric scoliosis?
Scoliosis usually causes no pain, so symptoms can often go unnoticed. Parents or caregivers should watch for the following signs in their child:
- Uneven shoulders.
- Constant leaning to one side.
- Uneven leg length.
- Prominent shoulder blade(s).
- An uneven waist.
- Elevated hips.
- If you notice any of these signs in your child, contact your doctor to have your child screened.
How is pediatric scoliosis diagnosed?
If you or a caregiver or teacher thinks your child may have scoliosis, contact your doctor as soon as possible.
An evaluation for scoliosis has several steps:
Your doctor will usually begin with a thorough history to determine if there is a family history of scoliosis. The history will also be used to screen for birth defects or trauma that may explain the curvature of the spine.
The doctor will then conduct a physical examination of your child's back, chest, pelvis, legs, feet and skin. The doctor will be looking to see if the child’s shoulders are level, whether the head is centered and whether opposite sides of the body look level.
The doctor will then ask the child to bend forward so that the back muscles can be examined, and to see if one side of the rib cage is higher than the other.
While checking the limbs, the doctor will be evaluating whether the limbs are the same length. He or she will also check for abdominal muscle strain, which could cause spinal curvature.
After a physical examination, the doctor may order an X-ray of the spine to confirm a diagnosis of scoliosis. The X-ray will be taken with your child standing so that the entire spine can be seen. The doctor will then measure the curves of the spine as shown on the X-ray. Curves that are greater than 25 degrees may require treatment.
If your doctor determines that your child has scoliosis, he or she will refer you to an orthopaedic spine specialist for treatment.
How is pediatric scoliosis treated?
The treatment for pediatric scoliosis depends on several factors:
- The type of scoliosis.
- The kind and degree of the curve.
- Your family history of scoliosis.
- Your child's age.
- The number of remaining growth years your child has until skeletal maturity.
- Most children with scoliosis will have mild cases that only require monitoring every four to six months.
If your child's doctor notices that the spinal curve is getting worse, he or she may prescribe the use of a custom brace to prevent it from progressing even more.
If the brace does not control the spinal curve, or if the curve is severe when the child is first seen, surgery may be necessary. This is usually recommended when the spinal curve is more than 45 degrees. Surgery has been found to be a very effective treatment for severe scoliosis.
How is pediatric scoliosis surgery carried out?
This article provides an overview the following pediatric scoliosis surgical approaches:
- Spinal fusion with instrumentation
- Magnetically controlled growing rods
- Vertebral body tethering or fusionless scoliosis correction
- Spinal Fusion for Pediatric Scoliosis
When surgery enters the scoliosis treatment conversation, spinal fusion is often part of the discussion, whether it is the primary surgery or included to support a separate scoliosis procedure. In simple terms, spinal fusion utilizes bone graft to stimulate new bone growth that "fuses" or biologically welds together two spinal bones into one solid bone over a period of time. Fusion adds stability to a spine that has been straightened surgically.
The goals of spinal fusion for childhood scoliosis may be to stop the progression of the abnormal curve or to correct the curve altogether. Whether the fusion will stop your child's curve from worsening or permanently fix it is based on your child's specific case.
- In-situ Fusion: Halting Curve Progression
If your child has a mild or moderate curve that will likely worsen, your spine surgeon may recommend an in-situ spinal fusion. In-situ means, "in its original place." This approach manages the curve before it becomes a problem. The curve won't necessarily be corrected by this type of fusion, but it should not progress. Most children will have some amount of spinal correction performed during this procedure.
Like other types of fusions, in-situ fusion may be performed from your child's back (this is known as posterior), through the front of the body (anterior), or a combination of both.
To help straighten and secure the fusion, your doctor may use instrumentation (such as rods and screws). Also, additional bone called bone graft will stimulate the fusion of two bones into one.
If your doctor thinks your child is too young for spinal instrumentation, your child will wear a brace or cast after surgery to support a healthy recovery.
- Spinal fusion with corrective instruments: Curve correction
Corrective spinal fusion is a surgical procedure that permanently corrects a deformity. Not all children are suitable for this procedure.
Your surgeon may use an anterior approach (front), a posterior approach (back) or a combined anterior-posterior approach.
If your child has a thoracolumbar and/or thoracic curvature, your spinal surgeon may choose the anterior approach for spinal fusion. Supportive spinal instruments are implanted on the spine side.
The anteroposterior approach is preferred by some surgeons to correct severe, rigid curvatures. It is also effective in preventing the "crankshaft phenomenon," which occurs when the abnormal curve shifts around the posterior fusion. In this procedure, one curve is approached from front to back. If there is a second curve, it is only approached from behind.
- Hemivertebra Removal for Pediatric Scoliosis
A hemivertebra is a misshaped spinal bone (vertebral body). A healthy vertebra is rectangular, whereas a hemivertebra is shaped like a wedge or triangle. A hemivertebra forms while the fetus is in the womb, and it may result in congenital scoliosis.
If your surgeon suspects your child's scoliosis will worsen, or the scoliosis is causing your child to lean and/or be off balance, the hemivertebra can be removed. Based on your child's specific situation, your doctor may use a posterior approach or a combination anterior-posterior approach to remove the misshaped bone. Most commonly, a posterior approach is used to excise (remove) the hemivertebra and to straighten the spine. Rods and screws along with spinal fusion join the bones above and below the removed hemivertebra—the instrumentation stabilizes the spine and holds the correction until the fusion heals the spine into a solid.
After surgery, your child may need to wear a custom brace or cast to promote healing and proper fusion of the bones
How long does it take to operate on a child with scoliosis?
During scoliosis surgery, the surgeon will sometimes use special equipment to keep an eye on the nerves that come from the spine to make sure they are not damaged. Scoliosis surgery often takes 4 to 6 hours. It can also be much longer if the involved area is larger.
What type of anaesthesia is used for pediatric scoliosis?
General anesthesia is administered for surgical repair of curvature of the spine (scoliosis).
How long does it take to recover from pediatric scoliosis surgery?
Full recovery may take 6 to 12 months. Your child will need lots of emotional support during this time.
Is it possible for my kid with scoliosis to exercise and engage in physical activity?
Yes. While exercise will not cure scoliosis, it may help to mitigate any future physical function loss in your kid over time. Keeping physically healthy and exercising helps boost your child's overall happiness and well-being.
Is it possible that my child's scoliosis may worsen if he or she participates in sports?
The most prevalent kind of scoliosis, adolescent idiopathic scoliosis, strikes between the ages of 10 and 16, when many kids are eager to participate in a plethora of middle school and high school sports and athletic activities.
But don't give up hope. Scoliosis will not worsen if you participate in sports. Participating in activities that improve flexibility and core strength, for example, may actually help your child's back discomfort. Scoliosis-friendly sports include:
Swimming, which demands your kid to engage all of his or her muscles at the same time, may help strengthen his or her core.
Gymnastics is a great way to increase your child's flexibility and core strength.
Should my kid refrain from participating in particular sports?
The majority of sports, including weightlifting, are typically safe. Children who have undergone back surgery, on the other hand, should avoid contact sports. Hockey, lacrosse, wrestling, and football are among them.
Basketball, soccer, tennis, and swimming are among activities in which your youngster may likely resume participation six months following surgery. However, consult your child's physician first.