Princeton NJ Schools Articles

"Scoliosis"

This is the 60th article written by the Pediatric Group, P.A. for Princeton Online

Some schools routinely screen their students for scoliosis. Since the screening evaluation is non-invasive and cost-free, and early diagnosis can prevent significant morbidity, some states have mandated screening in schools. Quickly performed screens of multiple children at once may lead to over-diagnosis. Once the condition is identified in school, a short visit to the child’s physician can easily confirm or refute the diagnosis.

The spine is constructed of a stack of round bones that are flattened on the top and bottom. These vertebral bodies are separated by resilient disks, which act as shock absorbers. More rapid growth of one half of the spine causes the column of bone to tilt laterally and rotate on its axis. We call this idiopathic scoliosis, because there is no apparent cause for the scoliosis. The earliest sign of idiopathic scoliosis, rotation of the chest wall, is detected by having the child bending over with the hands and feet exactly even and the knees straight. If scoliosis is present, the back will be higher on one side than the other. In early scoliosis, the spine may appear straight in erect posture. The risk of idiopathic scoliosis progressing is greatest in a preadolescent, since the growth potential is greatest in this age group. The most rapid change is usually during the adolescent growth spurt. This is why we examine scoliosis patients most frequently in this age group. Once growth is finished, there can be no more progression of idiopathic scoliosis.

Pediatricians begin screening a child for scoliosis when the child is born. Scoliosis found in an infant is most often due to a congenital spine malformation of one or more of the spinal bones. Scoliosis found in the preadolescent or adolescent is most often of the idiopathic type. A physician can measure the rotational angle of idiopathic scoliosis with a simple hand-held device called a “scoliometer.” Alternatively, a more precise measure can be obtained with spinal x-rays. Referral to an orthopedist who specializes in adolescent scoliosis is warranted if the child has growth potential remaining and the curve is at least an eight to eleven degree rotational angle as measured by a scoliometer. If there is any uncertainty about the severity if the curve at any given growth stage, it is always better to seek an assessment by a pediatric orthopedist.

Treatment of idiopathic scoliosis depends on the age of the patient and the severity of the curve. The decision to intervene is determined by the severity of the curve and estimation of long term disability. If the curve is mild, no treatment is necessary. Early treatment of significant scoliosis consists of a plastic brace molded to the torso. It is worn underneath the clothing to enhance cosmetic acceptability. Some children must wear the brace around the clock, while others who are more mildly affected, may only have to wear it through the night. If the curve is more severe, or it progresses despite the brace, then surgical intervention is necessary to prevent the long-term cardiac and pulmonary consequences of a constricted misshapen chest wall. The surgery for idiopathic scoliosis consists of permanently positioning rods in either side of the spine to maintain alignment. Needless to say, the best approach is early detection and treatment in an attempt to avoid the necessity of surgery.

If a fetus forms with an asymmetrical vertebral body, the spinal column tilts, causing externally what appears as scoliosis. This condition is less common than idiopathic scoliosis and is usually corrected surgically, if the severity of the problem requires intervention.

A moderately common cause of the appearance of scoliosis without actually having scoliosis is unequal leg length. Up to a one-half inch discrepancy in the length of the legs is considered normal. More than that can cause the pelvis to tilt in the vertical posture, which, in turn, tilts the spine. This situation is corrected by a simple insert in the shoe or a thicker sole for the shoe of the shorter leg.

Some ancillary health professionals claim to be able to ameliorate scoliosis by spinal manipulation. This approach may be successful for muscular asymmetry. It may also relieve discomfort associated with muscle strain due to an asymmetric load (bookbag). However, it is not likely to affect bone growth and will certainly not help a congenitally malformed vertebral body. Pursuing this course of treatment without first discerning the underlying cause of the scoliosis risks a delay of appropriate treatment, leading to the necessity for more aggressive therapy later.

The weight of a bookbag is often blamed for scoliosis. In fact, if a bookbag is carried on one shoulder, the muscle on one side of the back can enlarge giving the appearance of scoliosis without actually affecting the bones of the spine. None of the foregoing discussion deals with the appropriateness of heavy bookbags. When a child enrolls in a reputable outdoor wilderness program, such as Outward Bound® or the national Outdoor Leadership School® (NOLS), the instructors usually advise that a participant not carry a backpack weighing more than thirty percent of their body weight. Participants in these activities, although certainly are performing activities more rigorous than walking in the halls of school, are provided with backpacks that are fitted with a frame support and hip belt. If a typical bookbag (without support or hip belt) weighs about thirty pounds, it follows that a thirty-pound load could be appropriate only for a child weighing at least ninety pounds. Alternatives include having a child obtain a more structured backpack from a camping store (and using all the straps and belts properly) or taking advantage of new technologies by recording text book contents on disks (CD or DVD).

As always, if there is any question about your child’s spine, the best option is to consult his/her physician.

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