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Idiopathic Scoliosis and Scoliosis Screening
by Meegan Domangue, PA-C
Scoliosis is defined as a sideways curvature of the spine. The term “idiopathic” means that the cause is not known. Idiopathic scoliosis occurs in children and adolescents in 1.5% – 3.0% of the population. Cases of mild curvature are relatively equally as prevalent in girls and boys. Larger and more progressives curves that require treatment are more common, however, in girls.
Scoliosis can occur at any age. In children less than 3 years old, it is termed “infantile scoliosis” and usually results from congenital defects, neurologic disorders, or other syndromes. Juvenile scoliosis occurs between the ages of 3 and 10 but is quite rare. Adolescent idiopathic scoliosis is the most common form and generally occurs after 10 years of age. While most cases of scoliosis have no known cause, there is likely a genetic component since it can occur in several people in the same family.
Screening for scoliosis among students has become common in schools. The most common screening test is called the “Adam’s forward bend test.” This consists of the child bending forward at the waist to touch their toes. Any sign of asymmetry in the child’s back or one side being higher than the other warrants a referral to a pediatrician. This test can easily be performed at home as well by parents, especially if there is a history of known scoliosis in the family. If scoliosis is suspected it is completely acceptable to seek evaluation with the child’s doctor.
Scoliosis can be confirmed with an x-ray of the spine taken front to back while the child is standing upright. A lateral curvature greater than 10 degrees meets the definition of scoliosis and warrants monitoring. Many factors determine specifics on when and how often to x-ray, including age, gender, menstrual status and skeletal age. Generally, adolescents are monitored until they reach skeletal maturity, which is determined on x-ray by a Risser sign (measuring closure of a pelvic growth plate). If the curve is mild and remaining stable no treatment is needed. Progressive curves will generally require treatment and close monitoring. For less severe curves, physical therapy with core strengthening combined with intermittent x-rays may be adequate. A curve beyond 20 degrees, or progressing, warrants bracing in an attempt to stop the progression and avoid surgery. Surgery is indicated in a curve beyond 40-45 degrees prior to skeletal maturity, or beyond 50 degrees if skeletally mature.
Severe curvature left untreated can result in long term problems. This includes diminished lung capacity and restrictive lung disease on top of the obvious pain and cosmetic concerns. If there are any concerns about possible scoliosis or skeletal asymmetry, early detection and treatment can be extremely beneficial. Do not hesitate to take your child to his/her pediatrician or spine specialist for definitive testing and treatment options.