Our spine is naturally curved in order to distribute the weight of the body. A side-view X ray of a soldier standing rigidly at attention would show the cervical spine in his neck arched slightly forward. The twelve thoracic vertebrae curve gently to the rear. Then the lumbar spine, which bears most of our upper-body weight, arches forward as it nears the pelvis.
About one in twenty-five adolescent girls and one in two hundred teenage boys develop scoliosis. Captured on an X-ray, their spines form, to varying degrees, a more pronounced S shape. When imaged from the back, a normal spine exhibits no curvature. A youngster is said to have scoliosis if her curvature is greater than ten degrees.
The condition can occur as a complication of polio, muscular dystrophy and other central nervous system disorders, but four in five cases among teenage girls are idiopathic—that is, of unknown cause. Very often, though, a family member will also have had scoliosis.
Symptoms Suggestive of Scoliosis May Include:
- Conspicuous curving of the upper body
- Uneven, rounded shoulders
- Sunken chest
- Leaning to one side
- Back pain (rare)
Scoliosis can develop quietly for months to years so it may only be picked up by the pediatrician during an examination of the teen’s back. Progression may occur quickly during the teen’s growth spurt. One in seven young people with scoliosis have such severe curvature that they require treatment.
How Scoliosis Is Diagnosed
- Physical examination and thorough medical history
- X-rays
How Scoliosis Is Treated
- Bracing: Many such cases never progress to the point that treatment is necessary. Follow-up visits are scheduled approximately every six months for those diagnosed with curves between fifteen and twenty degrees.
Curvature above twenty-five degrees may call for bracing. There are two main types of orthopedic back braces. The Milwaukee brace has a neck ring and can correct curves anywhere in the spine; the thoracolumbosacral orthosis (TLSO for short, thankfully) is for deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back.
Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete; usually that’s about ages seventeen to eighteen for girls, and eighteen to nineteen for boys. The braces are more cosmetically appealing than they used to be and can be hidden easily under clothing. Having to wear an orthopedic brace interferes only minimally with physical activity. Only contact sports and trampolining are off-limits for the time being.
- Surgery: Posterior spinal fusion and instrumentation, the operation to surgically correct scoliosis, is typically recommended when the spine’s curvature is fifty degrees or more. The surgical procedure fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. On average, this takes about twelve months. Although teenagers who have the surgery still face some restrictions on physical activity, they can say good-bye to the brace.
Helping Teens Help Themselves
Only about 50 percent of young scoliosis patients wear their braces. Parents need to convey the importance of complying with the doctor’s instructions. At the same time, they should be sensitive to the tremendous impact the condition can inflict on a teenager’s body image, which at this age is inextricably entwined with self-identity and self-confidence. You might want to consider asking your pediatrician or orthopedist for a referral to a mental-health professional experienced in counseling children with chronic medical problems. A patient support group, like those run by the Scoliosis Association may also be helpful.