By Cheryl Lawing, M.D.
Scoliosis, which is a three-dimensional deformity of the spine most clearly seen as curving, is an issue that can affect children of all ages. The adolescent version is most common, and many states, including Florida, do school screenings for this. Many people assume that scoliosis does not affect infants and young children, but this is unfortunately not true. About 5 percent of patients with scoliosis have infantile idiopathic scoliosis, which is scoliosis in children younger than 4 who do not have any known cause for the spinal curvature.
The impact that scoliosis has on a patient largely depends on the age of the patient. Because scoliosis worsens as a child grows, younger children are likely to have much more severe scoliosis. Scoliosis in young children can create problems by limiting the room available for the lungs to grow. Fortunately, infantile scoliosis can be effectively treated, in many cases, if caught early. Mehta casting is a nonoperative means of treating infantile scoliosis that has proven highly effective. If started early, Mehta casting can make the curve disappear. Mehta casting works by harnessing the period of remarkably rapid growth that occurs in the first few years of life.
In older children and adolescents with an adequate amount of growth remaining, a brace can be used to harness a child’s growth and prevent progression of the curve. Bracing for adolescents with scoliosis is highly effective. In a highly powered study in the New England Journal of Medicine, adolescents wearing braces were able to avoid progression to surgery 72 percent of the time, compared to only 48 percent of the time in children without braces. These results were so dramatic that the study was stopped early at the interim analysis, because it was felt to be unethical to continue to not brace children. It is important to remember, though, that not every child needs a brace. Small curves are far less likely to progress and therefore your doctor may choose to observe the curve until it reaches a certain point.
Because we have effective treatments for scoliosis that can prevent progression, it is important to identify scoliosis early. However, scoliosis can be difficult to detect. It can be identified by looking for asymmetry of your child’s back, shoulders, waist and ribs. It can be difficult to examine babies, but placing them face down across your lap is a good way to examine their backs. Adolescent scoliosis can often go undiagnosed because it occurs at a time that children are shy about their bodies and parents often do not get a good look at their backs. Your pediatrician should be screening your child for scoliosis, and certainly it is good to discuss any concerns with him or her.
Please see Appointments and admissions for information on how to make an appointment with our spine care staff.