Paediatric scoliosis

On the whole adolescent scoliosis does not usually present with pain or neurological symptoms. In most cases the curve of the spine is not big enough to affect the hear or lungs and therefore shortness of breath is not seen in adolescent scoliosis. Other symptoms include:

• rib cage sticking out on one side especially at the back
• your hip or waist sticking out
• shift of the trunk to one side
• Obvious curvature of the back
• 1 shoulder appears higher than the other

Diagnosis of scoliosis is made through clinical examination and standing x-rays of the front and side of your spine. These x-rays are often done with a lead shield to protect you from radiation. Your consultant will measure the x-rays to estimate the size of your curve. This is measured in degrees and is described as a Cobb Angle.

A straight spine has a curve of 0º, any curve greater than 10º is considered scoliosis. In order to help with decision making regarding treatment; flexibility x-rays are taken as well. If surgery is being considered an MRI is requested to assess the spinal cord and surrounding nerves. If any neurologic abnormalities are identified your consultant may ask you to see a neurosurgeon before you start your treatment.

Adolescent idiopathic scoliosis can be treated in three different ways and is based on the risk of the curve getting worse, the three treatments include:

• Observation
  Observation is generally for growing patients whose curves are less than 25º, or for curves less than 50º in patients who have finished growing.
• Bracing
  Bracing is for patients with curves that measure between 25º and 40º whilst they are still growing. The aim of the brace is to stop the curve from getting bigger. This is done by correcting the curve while the patient is in the brace. There are different types of braces and you would need to discuss these with your consultant.
• Surgery
  Surgical treatment is used for patients whose curves are greater than 45º while still growing or greater than 50 º when growth has stopped. The goal of surgical treatment is two-fold: Firstly, to prevent the curve from getting worse and secondly to improve the shape of the spine.

In general, adolescent scoliosis curves get worse during growth spurts, and in adulthood if the curves are still relatively large after skeletal maturity.