Kids grow fast. In the case of scoliosis, a lateral (side-to-side) curvature of the spine, rapid growth may exacerbate the problem, although it can develop at any age.
“The most common time to detect curves is in late childhood or the early teen years,” says Dr. Lawrence Lenke, an orthopedic surgeon and nationally recognized expert in scoliosis with Washington University Physicians. “The most common form seen, Adolescent Idiopathic Scoliosis (AIS), is detected between ages 10 and 18, often just before or after puberty and the associated adolescent growth spurt.”
Lenke explains that small curves in the spine are almost equally found in boys and girls, but larger curves, which may require treatment, are seen far more often in females. “It is a bit unclear why that is the case,” he says. “It may certainly be a genetic tendency, and/or something relating to hormonal alterations or connective tissue adaptations for the potential for childbirth in females.”
Dr. Aki Puryear, an orthopedic surgeon on staff at SSM Cardinal Glennon Children’s Medical Center, also points to genetics as the primary cause behind most cases of scoliosis and notes that studies indicate there are probably several genes involved. Dr. Matthew Dobbs, a pediatric orthopedic surgeon specializing in pediatric spinal deformities at Washington University, is among the researchers currently studying the role of complex, multi-gene interactions in scoliosis and has co-authored with Lenke and others several peer-reviewed articles on scoliosis treatment.
Among the treatment studies Lenke currently is working on, the national, multi-center Bracing for Adolescent Idiopathic Scoliosis Trial (BRAIST), funded by the National Institutes of Health, soon will be yielding useful data. “Bracing is indicated only for children and teens who are still growing in order to attempt to slow or stop the scoliosis progression during the remainder of the child’s skeletal growth,” Lenke says, adding that it is only useful to treat relatively significant curvatures.
“There is a fair bit of controversy as to whether bracing is actually effective in this regard, and we are awaiting the results of the BRAIST,” he says. “Hopefully, this will shed some light onto this question because wearing a brace full-time for an active child or young teen can be a bit challenging, and compliance is often an issue.”
Mild curves, which are the most commonly diagnosed, are typically observed and treated only if they worsen, while very pronounced curves may require surgical correction. “There are some motion-sparing surgeries that are
being evaluated,” Puryear notes. “Physical therapy, chiropractic manipulation, electronic stimulation and medicines have all failed to permanently correct a significant, true scoliosis curve—that is, a curve that is not secondary to positioning, posture or leg-length inequity.”
Adults can develop scoliosis as a result of slow progression of untreated childhood curves or may develop curves in the lower portion of the spine due to age-related spinal degeneration. “Observation with physical therapy, aerobic activities, etc., are indicated for a vast majority of adult patients with smaller curves and minimal symptoms,” Lenke says. “Active, non-surgical treatment, such as epidural steroid or nerve
root injections, are indicated in the subset of adults who have spinal stenosis (narrowed spinal canal) and/or pinched nerves in the lumbar spine.” Surgery is reserved for adults whose adolescent scoliosis has progressed significantly or who are experiencing pain.
Most adolescents grow straight and tall, but parents should keep a lookout for signs of possible scoliosis: uneven shoulders, prominent shoulder blades, an uneven waist, elevated hips or leaning to one side. If you notice any of these signs, contact your child’s primary-care physician for a professional assessment.