Scoliosis in the Child
Definition
Scoliosis is the lateral deviation of the spine and affects not only adults, but more commonly affects children and adolescents.
Prevalence
4% of children aged 10-14 have detectable scoliosis. 60-80% of those affected are girls. While most cases of childhood and adolescent scoliosis stop progressing once spinal maturity is reached, progression of the curve past spinal maturity is not uncommon.
Types
Infantile - Infantile scoliosis is a lateral spine deviation occurring during the first 3 years of life and is twice as common in males. Approximately 74-97% resolve on their own but those that do progress do so in a severe and disabling manner. This condition is, however, rare in North America.
Juvenile - Juvenile scoliosis refers to scoliosis occurring in children aged 3 until the age of puberty - approximately 10 years of age. Juvenile scoliosis can continue to progress in severity, and thus, monitoring every 3-6 months with radiographs is required. Continual monitoring is performed through adolescence because of the high risk of progression. If progression occurs without appropriate treatment severe spinal deformity and cardiovascular compromise can result.
Adolescent - Adolescent scoliosis is scoliosis detected in those who have reached puberty but have yet to reach adulthood. This is the most common type of idiopathic scoliosis (unknown cause). Like juvenile scoliosis, adolescents should be monitored until spinal maturity is reached to prevent possible progression and future health problems.
Diagnosis
Since the abnormal curvature may not be obvious upon inspection of the back, even to the trained eye, an uneven shoulder height or clothes not appearing to hang off the body symmetrically may be the first indication. Also, a complaint of back pain, ache, discomfort or fatigue may be present. However, this does not generally occur until later stages after the spinal ligaments and muscles have been chronically irritated.
Complications
While most cases of childhood and adolescent scoliosis stop progressing once spinal maturity is reached, progression of the curve past spinal maturity is not uncommon. If the lateral curvature continues to progress, cardiovascular compromise can result - ultimately leading to severe disability or death.
Treatment
Scoliosis treatment in the child consists of:
- monitoring the degree of curvature for increases,
- chiropractic spinal adjustments to minimize spinal stresses, optimize biomechanics and keep the nervous system functioning properly,
- therapeutic spinal exercises and stretches to strengthen spinal muscles on the convex side and keep muscles flexible of the concave side, and
- soft tissue procedures and physical therapies to assist in symptomatic relief.
The goal is to eliminate discomfort and prevent progression of the lateral curvature. If the curvature continues to progress severe spinal deformity can occur resulting in physical disability and cardiovascular compromise.
