At some point during the school year, many area middle school students will be tested for Scoliosis. You may have been tested yourself in school or during a physical examination. But what exactly is scoliosis and how is it treated?
Scoliosis is a clinical deformity indicating a C or S-shaped curvature of the spine.
Approximately one to three in every 100 children are affected by some form of scoliosis, ranging from very mild cases not requiring treatment, to more severe cases that may require the child to wear a brace to prevent progression. The largest curves may require surgical fusion to prevent progression and to improve the clinical deformity.
Tamara A. Topoleski, M.D., a board certified orthopaedic surgeon specializing in pediatric orthopaedics at the Orlando Orthopaedic Center, reports that parents may notice asymmetry through clothing hemlines such as pant legs or shirt sleeves. Hip or shoulder asymmetry, or a tendency to lean to one side, may be indications of an underlying spinal curvature, or scoliosis.
Children with scoliosis do not necessarily complain of back pain. If your child complains of back pain, particularly with associated lower extremity numbness or tingling, a more serious spinal problem may be present. Any of these signs or symptoms warrant an examination by a medical professional.
Many schools conduct a screening test to identify potential patients with scoliosis. These screenings occur during middle school to coincide with the rapid adolescent growth phase. The simple, painless screening test, known as the Adam’s Forward Bending Test, can even be performed by parents at home.
Children simply bend forward at the waist while keeping their knees straight and arms dangling with fingers locked toward their toes. The screener will then look for asymmetry through the rib cage and shoulder blades or lower back which may indicate a curve in the spine. This test is effective in detecting scoliosis in both the upper and lower back.
Although the Adam’s Forward Bending Test is a reliable screening tool, a small percentage of curves in children with excessive body weight can be missed if examined by an untrained screener.
We recommend that parents be vigilant for any clinical changes in the appearance of a child’s spine, shoulders and knees, particularly during the adolescent growth spurt.
When a curvature of the spine is detected during a school screening, the child is then typically referred to either their Primary Care physician or an Orthopaedic Surgeon. Further diagnostic tests such as radiographs may be ordered.
The child’s age, the level of maturity and magnitude of the curve determine the best method of treatment. In some cases, simple observation with radiographic follow-up is the only treatment required. More significant curves may require the use of a brace.
Several styles and wearing protocols are currently available and effective. Bracing is the only nonoperative method of treatment with reliable data suggesting that the natural history of scoliosis can be altered. More severe curves that have demonstrated progression may require surgical intervention. Treatment is most effective when scoliosis is detected early.