Scoliosis screening: Why early intervention is important for kids

“When we identify scoliosis early, we can often begin nonsurgical treatment to prevent the curvature from worsening and needing surgery later,” said Dr. Aki Puryear, pediatric orthopedic surgeon at Riley Children’s Health.

There are three types of scoliosis: congenital scoliosis (present at birth), neuromuscular scoliosis (caused by conditions like spina bifida and cerebral palsy) and the most common form, adolescent idiopathic scoliosis, whose cause is unknown.

How to do a scoliosis screening

Scoliosis screening is a routine part of physical exams during well-child visits to the pediatrician or family doctor. Scoliosis screening age varies by gender, but it typically occurs around the end of elementary school for girls and during middle school for boys. Your child’s doctor will begin with a simple “forward bend test” to check the spinal curve.

“In this test, the child bends forward as if they are going to dive into a swimming pool,” Dr. Puryear explained. “If one side of the body lifts higher than the other as they bend forward, it indicates they may have a rotational deformity.”

If a forward bend test shows a spinal curvature, your child’s doctor may order a “long film” x-ray to view your child’s entire spine. Riley Children’s Health offers EOS imaging, which captures these long images using a lower dose of radiation than traditional x-rays. These images help the doctor determine the size of the curvature. Curves 10 degrees or more are considered scoliosis.

What age do you start screening for scoliosis

The treatment for scoliosis depends on the degree of curvature in your child’s spine and how much more growing they have left. For instance, a girl with a 20-degree curve who’s two years past her first menstrual cycle is nearing the end of her growth. However, a boy with a 40-degree curve at 13 years old can continue to grow into his 20s and may benefit from an early intervention. For some children, it begins with simply monitoring their growth and curvature through observation.

“We use the child’s hand to monitor where they are in terms of growth, or we can mark a spot on their pelvis to follow how much they grow over time,” Dr. Puryear said. “We’ll measure them every six months to see if they’ve reached a plateau or are still growing.”

For smaller curves and less complex instances of scoliosis, your child’s doctor may suggest:

1. Observation to see if the curve worsens or stays the same.
2. Physical therapy to improve core strength and flexibility. Riley offers Schroth Method physical therapy, which is specifically designed to for scoliosis correction.
3. Back braces for curves between 20 to 40 degrees. When worn 18 to 20 hours a day, these custom-fit back braces increase the chance of avoiding surgery by nearly a third. (Casting is available for very young children with scoliosis.)

The goal of an early intervention like a back brace is to stop spinal curvatures from worsening, and they can sometimes improve the curvature.

“If you imagine a tomato plant growing sideways, we put stakes in the ground so plant can grow straight up along the stakes, as opposed to sideways,” Dr. Puryear said. “With growing children, if we see they start to bend like a tomato plant growing sidewise, we try to stabilize them to grow straight.”

Surgical interventions for scoliosis

Surgery is an option for children with a severe spinal curve measuring more than 45 degrees that continues to progress. The goal of spinal surgery is to prevent scoliosis from worsening irreversibly into adulthood.

Spinal fusion surgery is the most common type of surgery used to treat scoliosis because it is effective and permanent. This procedure fuses together vertebrae into proper alignment and holds them in place with rods and new bone growth. The fused area will no longer bend or grow, but the vertebrae above and below this area allows for continued motion and growth.

Children must wait to undergo spinal fusion until they’re mostly done growing, so there are other options to address spine curvatures until then:

• Growing rods are surgically placed along a child’s spine to guide healthy growth. Children begin a schedule of straightening the rods every few months as they grow. Newer styles of rods allow this to be done in clinic using an external magnet rather than repeat surgeries.
• Non-fusion surgery, or “tethering,” offers more movement than fusion surgery and is growing in popularity. This type of surgery places screws in the vertebrae that are attached to a flexible tether to pull the spine into alignment. Tethering treats specific, single-curve scoliosis and relies on the child’s future growth, so it may require additional treatments.

Whether your child’s scoliosis simply needs to be monitored or requires an intervention, speak with your doctor about your concerns. Physicians who treat scoliosis see patients of every age and with every degree of curvature; they’re prepared to answer your questions.

“Parents are often most concerned about not doing anything at all and then that decision harming their child later. We all want to do the best for our children, so even if it’s a five-degree curve, we want to give you the time to voice your concerns,” Dr. Puryear said. “Our job is to understand where you’re coming from, educate you on what we think will happen and monitor it with you to make sure it isn’t a problem later.”