Pediatrics - Scoliosis, Curvature of the Spine 

Introduction
Scoliosis is an abnormal curvature of the spine.  A healthy spine has natural front to back curves.  Scoliosis is a condition that describes side to side curvatures of the spine, which often also involves rotational deformities.  Some people are born with scoliosis, or it may result from neuromuscular conditions, osteoporosis, or for unknown reasons (idiopathic scoliosis). 
 
Scoliosis is a progressive condition that can become worse over time.  Untreated severe curvatures can cause medical complications.  Scoliosis may be monitored or treated with back bracing or surgery.

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Anatomy

Your child’s spine is made up of a series of bones called vertebrae.  There are different areas of the spine, defined by their curvature and formation.  Your child’s spine has natural front to back curves.  Ligaments and muscles connect to the spine and provide stability and movement.

Your child’s neck contains the cervical spine.  It is composed of seven small vertebrae.  Your child’s chest area contains the thoracic spine, with 12 vertebrae.  The lumbar spine is located at and below your child’s waist.  It contains five large vertebrae.  The remainder lower vertebrae in the spine are fused together or uniquely shaped in formation with your child’s hip and pelvis bones. 

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Causes
Scoliosis is an abnormal curving of the spine.  With scoliosis, an abnormal curve occurs from side to side or from the right or left of the spine.  Some people are born with malformed vertebrae, unequal leg lengths, or fused ribs that causes congenital scoliosis.  Neuromuscular conditions, such as cerebral palsy, muscular dystrophy, spina bifida, and polio can cause poor muscle control, muscle weakness, or paralysis that leads to scoliosis.  If the cause of scoliosis is unknown, it is termed idiopathic scoliosis.  Idiopathic scoliosis tends to develop during a child’s growth spurts.  Children are routinely screened for scoliosis in most school systems.  In adults, scoliosis may develop because of degenerative changes in the spine, including osteoporosis.

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Symptoms
Scoliosis causes the spine to curve to the side.  This may cause one shoulder or one hip to appear higher than another.  Your child’s body may lean to one side and his or her shoulder blades may stick out.  Your child may experience back pain and fatigue.  A severe curvature can make it difficult to breathe or cause pressure on the spinal cord or nerves.  Arthritis in the spine may develop with aging.
 

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Diagnosis
As always, the diagnosis of scoliosis begins with a medical history.  Your doctor will examine your child’s spine and perform a neurological examination of the extremities.
X-rays are used to show and allow measurements of the curve in the spine.  X-rays are taken from the front and sides.  Magnetic resonance imaging (MRI) scans or CT scans may be used to provide more detailed images.

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Treatment
Spine curvatures of less than 20 degrees are usually monitored frequently by a doctor but do not require treatment.  Back bracing may be used to treat curvatures that are 25 to 30 degrees.  There are many different types of back braces.  They work by using pressure to straighten the spine.
Back bracing is appropriate for children with idiopathic scoliosis that are still growing, but it does not work well for those with congenital or neuromuscular scoliosis.

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Surgery
Surgery is usually required for spine curvatures that are greater than 40 degrees.  Curves greater than 40 degrees have a high risk of getting worse, leading to potential complications.  Spinal fusion surgery is used to correct the curve in the spine and connect the vertebrae together.  The vertebrae are fused together with surgical hardware, such as rods and screws.  A back brace may need to be temporarily worn while the spine heals.  In some cases, additional surgeries may be necessary over time.

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Recovery
Recovery from bracing or surgical treatments is very individualized and depends on many factors, including the extent of curvature, age, and other medical conditions.  Your doctor will let you know what to expect.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.