Scoliosis Awareness Month: What is Scoliosis?

Scoliosis Awareness Month: What is Scoliosis?

What is it?
Scoliosis is not a disease. It is an abnormal curvature of the spine. In addition to the spine curving sideways, it also twists, making the ribs (which are attached to the spine) look uneven. This may cause a prominence or a “bump” on the back. Other signs include a shoulder or hip that looks higher than the other or the chest may appear uneven. Scoliosis is usually a painless condition. Children with scoliosis are no more likely than kids without scoliosis to have back pain.

The diagnosis of scoliosis is confirmed by taking an X‐ray of the spine. If a curve measures more than 10 degrees, it is called scoliosis.

Who has it?
Scoliosis usually occurs in early adolescence and becomes more noticeable during a growth spurt. Approximately 0.5 percent of young people develop scoliosis that requires treatment. Girls have scoliosis eight times more often than boys. Sometimes scoliosis can be found in several family members, for several generations.

Why does it happen?
There are several different types of scoliosis that affect children.

Idiopathic Scoliosis
The most common type of scoliosis is idiopathic, which means the exact cause is not known. Idiopathic scoliosis can occur in infants, toddlers and young children, but the majority of cases occur from age 10 to the time a child is fully grown. Scoliosis tends to run in families. It is not a disease that is caught from someone else like a cold. There is nothing you could have done to prevent it. It is not caused by carrying heavy books, backpacks or purses, slouching, sleeping wrong or from a lack of calcium.

Congenital scoliosis
Congenital means that you are born with the condition. Congenital scoliosis starts at the spine forms very early in pregnancy. Part of one or more of the vertebra does not form completely, or the vertebra does not separate properly. Other abnormalities may also be present such as ribs may be missing or there can be ribs that are fused together. This type of scoliosis can be associated with other health issues including heart and kidney problems.

Neuromuscular scoliosis
Any medical condition that affects the muscles and the nerves can lead to scoliosis and this is known as neuromuscular scoliosis. This is most commonly due to muscle imbalance and/or weakness. Examples of neuromuscular conditions that can lead to scoliosis include cerebral palsy, spina bifida and muscular dystrophy.

How is it found?
Finding scoliosis is easy when the back is examined closely but it can be missed if someone isn’t looking for it. Parents or friends might notice the curve, but most curves are found through a school screening program or by a pediatrician. A trained examiner can detect even a slight curve when a person bends over to touch her or his toes. If a curve is suspected, a referral is often made to an orthopedic doctor. Print this PDF.

What may be noticed on someone who has scoliosis:

  1. One shoulder may be higher than the other.
  2. One scapula (shoulder blade) may be higher or more prominent than the other.
  3. When the arms hang loosely at the side of the body, there may be more space between the arm and the body on one side.
  4. One hip may appear to be higher than the other.
  5. The head may not be centered exactly over the pelvis.
  6. The waist may be flattened on one side; skin creases may be present on one side of the waist.

What are the types of curves?
Curves occur in the spine between the neck and the pelvis. They are named depending on their location. The most common type is in the upper back (thoracic) and tends to curve to the right. Other curves are in the lower (lumbar) spine. Many children have both types of curves.

How are curves treated?
Treatment depends on how big the curve is when it’s detected and how much growth is left. Curves can worsen during the major growth spurts. Curves less than 20 degrees may not need any treatment except to be checked by the doctor from time to time until the child has stopped growing.

If a child is still growing and the curve is greater than 20 degrees, the doctor might recommend wearing a brace. Bracing will not correct a curve. The goal of bracing is to help prevent the curve from getting worse during growth. Braces must be worn as prescribed by the doctor during the growing years in order to be effective. After growth is completed or if the curve does not respond to bracing, the brace is no longer worn.

If a curve is advanced, the doctor may suggest an operation to correct the scoliosis. Allowing a large curve to progress could interfere with heart and lung function in later years. The most common type of operation is called posterior spinal instrumentation and fusion. Instrumentation refers to metal rods and screws that are attached to the spine to hold it in the corrected position. Fusion refers to the bone graft that is placed along the spine making the vertebrae one solid piece.

Learn more about the importance of scoliosis screening.

Share Your Story: Hole in One

Share Your Story: Hole in One

Meet Phoebe, a patient seen by our spine experts. Learn more about her journey below.

Blog written by Phoebe’s mom, Victoria of Rockwall, TX.

When Phoebe was in sixth grade, she had her annual pediatrician visit and that was when our doctor first recommended further evaluation of her back. Phoebe’s shoulders were uneven, and she appeared to have an abnormal spinal curve. Our pediatrician recommended that we go to Scottish Rite for Children.

Phoebe became Dr. McIntosh’s patient and due to the degree of curvature in Phoebe’s spine, a scoliosis back brace was highly recommended and necessary to stop the progression of the curve. As a mother of a beautiful, young and active daughter, the news was a hard pill to swallow. We were very nervous and afraid of how the brace was going to impact our daughter’s lifestyle. Dr. McIntosh was very understanding and thorough, answered all our questions and made us, especially Phoebe, feel comfortable.

Dr. McIntosh is an expert and we felt confident that our daughter was in great hands.

That same day, we met with Kelsey in the Prosthetics department. She took measurements and designed Phoebe’s back brace. Phoebe loved all the staff and doctors but felt a special connection with Kelsey. She was funny, young at heart and spent a lot of time with Phoebe during the brace adjustments.

At that time, Phoebe was 11 years old and about to transition from elementary to middle school. It was hard to see her wear a thick plastic brace during the hot 100+ degree weather. Phoebe has always been tough, and she rarely complained. She didn’t like the brace, but she knew that it was the only option to stop the curvature progression. Many times, she would even wear it for more than the 20 hours a day that was recommended. She started with a 19-degree curvature and at the end of the process, she was at a 17-degree curvature, which was great.

As a family, we did different activities together and allowed Phoebe to try many different sports. Phoebe was able to play soccer and basketball, run track, and even participated in cheerleading – all throughout her bracing process. Dana Dempsey, the Scottish Rite Director of Therapeutic Recreation, invited us to participate in a Learn to Golf clinic. It was at this clinic when Phoebe decided to try golf and she fell in love with the sport! Through the years, she has participated in several different Learn to Golf clinics and is now on the varsity golf team at her high school. She even made the varsity team as a freshman!

We are beyond grateful for all of the staff and volunteers at Scottish Rite. Phoebe’s scoliosis experience was much brighter due to the care and love she felt, and we strongly recommend Scottish Rite to anyone else that may be going down this path.

Learn more about Phoebe’s Story and see how Learn to Golf changed her life. Click here.

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Things to Know About Scoliosis Screening

Things to Know About Scoliosis Screening

After summer break, many kids will be screened for scoliosis. Here is some information that you should know about the process:

  • What is scoliosis? Scoliosis is a progressive condition causing the spine to curve or twist into a “C” or “S” shape.
  • What causes scoliosis? The most common form of scoliosis is idiopathic, meaning there is no known cause. Despite some popular beliefs, scoliosis does not result from carrying heavy items, athletic activity, sleeping/standing postures, or minor lower limb length discrepancies. Researchers at Texas Scottish Rite Hospital for Children identified the first genes associated with idiopathic scoliosis and hope the discovery will one day lead to identifying the cause of the spinal curvature.
  • How is it diagnosed? Scoliosis usually occurs in early adolescence (5th – 9th grade), becoming more noticeable during a growth spurt. The child’s physician or school nurse will screen for scoliosis by having the child perform the Adam’s Forward Bend Test to look for any unevenness or abnormalities in the shoulders, ribcage or back. They can also screen using a device called the scoliometer or by taking an X-ray.
  • Treatment: If your child has been told they have a curvature in the spine, their physician or school nurse can refer them to a health care provider such as Texas Scottish Rite Hospital for Children. From there, the physician will find the proper treatment method for your child.
  • Note: Approximately 5 percent of the patients referred to Scottish Rite Hospital will need treatment:
    • 50 percent – are determined not to have scoliosis and are released from care
    • 45 percent – need observation
    • 2 percent – need a brace
    • 3 percent – need surgery

Watch this video from our Assistant Chief of Staff Dr. Karl Rathjen.