The Medical Minute: Scoliosis screening key to timely treatment

HERSHEY, Pa. — One out of every 25 children will develop scoliosis, or curvature of the spine. While some are babies or toddlers when diagnosed, most cases occur during the pre-teen years.

Although doctors don’t know what causes scoliosis, there seems to be a genetic link. Girls also are more likely than their male counterparts to develop the condition, which is why the Scoliosis Research Society recommends they be screened twice during their developing years. Boys, on the other hand, are typically only checked once.

School nurses and pediatricians screen for scoliosis by checking for abnormalities in the back or asymmetry – maybe one shoulder is higher than the other, or the hip, pelvis or chest wall is more pronounced on one side.

“Initially, it’s more of a physical observation,” said Dr. Scott Sorenson, a pediatric orthopedic surgeon at Penn State Children’s Hospital. “They don’t usually complain of pain.”

Children with a curvature of less than 25 degrees, as measured on X-rays, are placed under observation.

Spinal curves from 25 to 45 degrees typically require a brace worn for 13 to 18 hours a day for a year or two to prevent the curve from worsening and to guide future growth.

When a curve reaches 50 degrees, discussions of surgical correction begin.

“That’s the point where we’ll usually see the curvature continue to increase no matter how mature your bones are,” Sorenson said. “Plus, it’s easier and safer to fix a 50-degree curve than one that is 80 degrees.”

Surgery typically involves placing screws at each level of the spine needing correction. The screws are attached to two rods running along the spine to realign the bones.

“Usually it occurs in the thoracic spine where your ribs are, so it’s not a huge deal to fuse because that’s already a pretty rigid part of the spine,” Sorenson said. “If we have to go lower in the back, it can affect motion and bending.”

Doctors place younger children in a full-torso cast that is changed every few months for a year or 18 months to correct their curvatures. For pre-adolescents who are growing too fast for their bones to be fused, a new technique allows surgeons to implant growing rods along the spine if surgery is deemed necessary.

Mild cases of scoliosis typically require no treatment and don’t affect a person’s health and activity. Those with more severe curvature – 80 degrees or more – may experience diminished lung or heart function, an increased likelihood of developing arthritis and possible troubles with self-esteem, Sorenson said.

Sorenson said he always gets questions about whether yoga, physical therapy and chiropractic care can prevent or alter the course of scoliosis. His response: “Those are all very important for helping with your posture, strength and overall conditioning, but none of them have been scientifically proven to alter the course of scoliosis.”

More information:

  • The pediatric orthopedic specialty program at Penn State Children’s Hospital, which ranks among the 50 best in the nation according to US News and World Report, can be reached at 717-531-7123.

The Medical Minute is a weekly health news feature produced by Penn State Health Milton S. Hershey Medical Center. Articles feature the expertise of faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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Last Updated October 12, 2017