FAQ Category: Child

The normal spine is straight from neck to buttock when viewed from the back (posterior view). Scoliosis is a curvature of the spine. It can be seen on X-ray as an abnormal C-shaped (one curve) or S-shaped curvature (two curves).

The type of scoliosis your daughter has is called adolescent idiopathic scoliosis (AIS). This type occurs in children between 10 years and when growth is finally complete.

The term idiopathic means no one knows what causes the condition to occur. A sudden, large growth spurt is one possible cause. This is just a theory and hasn’t been proven yet. There are many children who experience a sudden, large amount of spinal growth without developing scoliosis. This suggests there are other factors besides fast growth.

Sometimes in children who have growth spurts, the front half of the vertebral bone grows faster than the back half. Researchers are studying what may cause this to happen. One theory is that the position of the pelvis and sacrum at the base of the spine is the central key.

We do know that the position and angle of the sacrum has an effect on the sagittal alignment of the spine in normal adolescents and adults. Sagittal refers to a view of the spine from the side rather than from the back. Scientists are studying the relationship of the sacrum to scoliosis when sagittal angles are measured.

A recent study comparing pelvic and sacral angles in normal children and children with scoliosis was reported. They found all children with scoliosis had changes in the sagittal angle of the sacrum compared to children without scoliosis. It didn’t seem to matter at what level the scoliosis occurred in the spine.

Scoliosis is an abnormal curvature of the spine. Any part of the spine can be affected including the cervical (neck), thoracic (middle), or lumbar (low back) vertebrae. Most often the thoracic and lumbar spine are affected the most.

At first, the vertebrae curve to one side forming the C-shaped curve you mentioned.At first, a C-shaped curve causes the shoulders and hips to tilt down on one side. In an effort to keep the head in the middle, the spine may com-pensate by curving the lower part of the spine in the other direction, forming an S-curve. If the scoliosis progresses, the vertebrae may rotate, which makes the waist, hips, or shoulders appear uneven.

A specific cause of scoliosis is unknown. We call this idiopathic. Idiopathic scoliosis is the most common type. It tends to run in families and is more common in girls than in boys. Most often it develops in middle or late childhood during a rapid growth spurt.

So whether it is caused by hormonal changes, genetic mutations, or sudden and rapid growth spurts remains a mystery. And why it starts in one part of the spine instead of another is also an unknown.

Scientists are studying the position of the pelvis and sacrum at the bottom of the spine to see if there’s any connection. Pelvic angles and pelvic tilt are important to spinal alignment. Perhaps too much tilt one way or the other causes the bones to shift or grow more in the front than in the back.

Taking X-rays of thousands of normal children and comparing them later to X-rays of those children who develop scoliosis may help piece the puzzle together. Smaller studies of this type are already underway.

If your pediatrician is up to date with the current clinical practice guidelines(CPGs) for scoliosis, there will be no need to start with a specialist. The pediatrician who follows the CPGs will know when to take X-rays and when the X-rays suggest treatment is required.

Training, education, and increased awareness are needed about scoliosis. Parents, teachers, school nurses, and physical therapists can all help make sure no one falls through the cracks. A late diagnosis can mean the failure of treatment.

Children who see their pediatrician every year for an annual check-up should be screened for scoliosis so long as they continue to grow. The most likely time to spot a problem is between 11 and 14 years of age.

Some family’s decision is made based on the type of health insurance is available and the resources offered. If it turns out your daughter does, indeed, have scoliosis, it will be important that you follow-up with whatever recommendations are made. This will insure she has the best result possible.

Chronic low back pain in a young person can be very puzzling. Before advances in technology with MRIs and CT scans, we only had X-rays to rely upon. If the cause of the pain didn’t show up as a fracture, tumor, or other serious back problem, it was assumed to be psychologic.

Today, young people like yourself are very active and involved in sports. You may have injured your spine with a sport-related trauma that you aren’t even aware of. And recent research has identified a couple of conditions in young patients that were previously thought to be only seen in older adults.

One of these is called degenerative disc disease (DDD). In your age group this is referred to as juvenile DDD. With DDD, the disc between two vertebrae bulges or even herniates and protrudes out of its protective covering. The bulge or protrusion pushes directly back against the spinal cord causing back and/or leg pain.

Another cause of chronic low back pain in older adults that can also affect young people is called spinal stenosis. This is a narrowing of the spaces where the spinal cord and spinal nerves are located.

But before jumping to any conclusions about the cause of your pain, see a doctor. There could be a simple explanation for your symptoms. Most causes of back pain that are identified early and treated quickly have a good result.

Scoliosis is a deformity in the spine that causes an abnormal C-shaped (one curve) or S-shaped curvature (two curves). The spine is not straight but curves to one or both sides.

There are three types of scoliosis depending on when it develops. Infantile occurs from birth to three years of age. Juvenile scoliosis develops between four and nine years of age.

Adolescent presents between 10 years and when growth is complete. You probably have adolescent idiopathic scoliosis (AIS). Idiopathic means there’s no known cause. Adults can also have scoliosis.

Bracing is often used to keep the curve from progressing (getting worse). X-rays are taken on a regular basis to watch the curve. If it starts progressing, then bracing is considered. Until recently, the standard of treatment was that bracing was used when the curve reached 25 to 35 degrees.

New studies suggest the results may be even better if bracing is started earlier. It may be that bracing should begin when the curve is between 20 and 24 degrees. This is suggested if the curve is indeed getting worse and if the child is still growing.

It’s important to keep any follow-up appointments with your doctor. He or she will be the best one to advise you about treatment. As you think about questions you may have, write them down on a piece of paper.

Take your list with you to your next appointment. Don’t hesitate to show the physician your list. The more you understand about your condition, the better your treatment results may be.

Loss of correction after bracing for scoliosis is fairly common. It doesn’t happen to everyone but many patients see some changes when they stop wearing the brace.

Scientists are working to improve the long-term results of conservative care for scoliosis. Physical therapists are studying ways to improve results with exercise. Orthotists (brace makers) and doctors are working together to find ways to improve the bracing.

One brace in particular has been reported to maintain the correction or stabilization. The SpineCor brace has been shown to keep positive outcomes for up to two years so far. This type of brace is specifically designed for each person based on the presence, location, and type of curve present. It has a neuromuscular biofeedback component that seems to make the difference.

If your daugher has reached skeletal maturity (bones have stopped growing) then bracing is no longer an option. If her curve progresses too far, a spinal fusion may be needed.It’s a good idea to continue seeing her family doctor or her surgeon for regular follow-up to assess the need for further treatment.

Today’s athletics are so competitive, sometimes coaches are short-sighted. It’s easy to think only in terms of whether or not the athlete can finish playing the game, rather than what’s best for the player.

This is particularly true with young players who haven’t completed their bone growth yet. Knee injuries are especially difficult to tell what’s wrong. As you suggest, it may be best to use the standard first-aid formula: R.I.C.E. rest, ice, compression, and elevation.

Nothing should be done that could further damage the injured soft tissues. Instability from ligament damage or even bone fracture must be ruled out before returning the athlete to the field. A medical doctor should be relied upon for this kind of evaluation and diagnosis.

Injuries in young athletes are becoming more common now. The increased participation of so many children in sports of all kinds has posed some unique problems.

What we are finding is that a delay in diagnosis and treatment isn’t always a bad thing. Many times conservative care is advised until a proper diagnosis can be made. Knee injuries range from ligament rupture to meniscal tear to fracture.

And in the young athlete, injury can occur to the growth plate. The growth plate is a fibrocartilage cap at the end of the bone. It allows the bone to continue to grow while protecting the ends.

It may be best to wait to repair ruptured ligaments until bone growth is complete. In the case of an anterior cruciate ligement (ACL) tear in the knee, tunnels are drilled through the bone as part of the reconstruction surgery. Surgeons try to avoid drilling through the growth plate. The operation is put off until about one month after growth is complete.

The downside of this for the active athlete is that sports participation must be limited. A conditioning program can be allowed but competitive play and practice is not. In the big picture, the goal is to preserve joint function and stability.

Losing a season to recovery and rehab is disappointing but necessary for full recovery. With the right treatment, many patients return to full sports play at a level equal to their pre-injury status.

Your pediatrician is following the current best practice guidelines known. These are based on the latest research. Scoliosis less than 25 degrees is observed carefully and watched for rapid change or progression (getting worse).

In the past, exercises were not found to be helpful with scoliosis. Today, newer studies may have found a more effective way to use exercise with mild scoliosis. And whereas bracing was initiated with the curve was between 35 and 45 degrees, newer research suggests bracing at 25-degrees may be better.

New studies are coming out that can compare the results of one brace against another. They are using some standard criteria for patient selection. They also applied standard study methods from study to study.

Better brace designs also means better patient compliance. In other words, with a more comfortable, better looking brace, children are more likely to wear the brace enough to see a difference.

Today’s studies indicate that the use of bracing in smaller curves (25 to 25 degrees) has a better outcome compared to waiting until the curve is 25 degrees or more. Your chances of avoiding surgery for a progressive curve are better if treatment with bracing is started sooner than later.

A vertebra is the name of the bones in the spine. A hemivertebra refers to the development of only half of the bone. Usually a line drawn down the middle of the vertebra would form two identical halves. A hemi-vertebra is missing one half.

The hemivertebra could be an extra bone that started to form but didn’t finish. Or it could be one of the regularly present bones that is missing half of its parts. The most likely cause of hemivertebrae is a lack of blood supply. Because it forms during the child’s development in the womb and is present at birth, the condition is congenital.

A hemivertebra may not be a problem. But in some children, it can cause compression of the spinal cord. It changes the shape of the vertebral canal where the spinal cord passes. Pressure on the spinal cord or spinal nerves can cause serious neurologic problems.

Hemivertebra are also wedge-shaped. The unevenness of the spine from the extra, half-vertebra that is wedge-shaped can cause a change in the angle of the spine. Depending on the location, this may be a kyphosis, scoliosis, or lordosis. With kyphosis, the spine is curved forward when viewed from the side. Scoliosis refers to a C-shaped or S-shaped curve of the spine when viewed from the back. Lordosis is an excessive swayback position of the low back area.

Surgery to remove the bone is sometimes advised. This can be done safely and usually in one operation. The goal is to restore normal spinal alignment. Excellent long-term outcomes have been reported in studies.

Hip dysplasia refers to a shallow hip socket. Without a deep enough socket, the round head of the femur (thigh bone) can slip out. This is called a subluxation. If it comes out all the way, it’s a dislocation.

In children, the proper development of the hip socket and round surface of the femoral head depends on the force and pressure from weight-bearing. Standing up and walking are the major activities that help develop the hip. If the hip is not properly positioned, the compressive load will cause further deformity.

Joint damage leading to hip dislocation and later to arthritis occurs because of the abnormal mechanics of the hip joint with dysplasia. The results of studies are clear: treatment to correct the problem is important. You are on the right path in following your surgeon’s advice.

Problems can occur with any surgical procedure. The medical staff is required to alert you to all the possible things that can go wrong. There is a chance that something can happen but the risks are fairly low. The positive benefits of this operation outweigh the potential problems.

The young girl may have a condition called Blount disease. Curvature or bowing of the lower leg is usually present in young children. This comes from the position they were in while in utero (in the uterus). The legs start to straighten out once the muscles of the lower back and legs are strong enough to hold the child in the upright position.

With Blount disease there is abnormal growth of the bone causes the bowing to get worse instead of better over time. There is abnormal compressive forces across the growth plate of the tibia (lower leg bone). Growth is stopped and deformities can occur.

There are three types of tibia varum based on the age it begins: 1) infantile (less than three years old), 2) juvenile (occurs between four and 10 years), and 3) adolescent (11 years of age and older).

About 40 per cent of the children with Blount disease develop it at a later age. It occurs during late childhood and early adolescence when growth is most likely to take place.

We don’t really know what triggers Blount disease. Juvenile or adolescent Blount disease is usually caused by obesity (being overweight). But it can also be the result of infection or trauma that disrupted the medial growth plate. The fact that not all overweight children develop Blount disease suggests other factors as well.

Blount disease is an extreme case of bow legs that children don’t grow out of.
Bowlegs also known as tibia varum (singular) or tibia vara (plural) are common in toddlers and young children. The condition is called physiologic tibia varum when it’s a normal variation. The child will grow out of this type of bowing.

Most toddlers have bowlegs from positioning in utero (in the uterus). This curvature remains until the muscles of the lower back and legs are strong enough to support them in the upright position. By the time the child is three years old, this bowing should be much improved.

In some cases abnormal growth of the bone causes the bowing to get worse instead of better over time. This condition is called Blount’s disease or pathologic tibia varum.

With Blount disease there is an abnormal amount of compressive force across the growth plate. This causes growth to stop and deformities to form. The younger the child is when this problem is discovered, the greater the chances for more deformity.

Previous studies show that left untreated, Blount disease gets worse. The deformity becomes greater. The child’s walking pattern will be affected. There can be enough of a difference from side to side to cause one leg to be shorter than the other. Early arthritis can develop, too.

Early treatment is the key to a successful result. The child’s parents should be made aware of the likely results without treatment.

Simply stated, no one knows the answer to this question. The reason is because it’s not considered ethical to treat one group of children with bracing and compare them to a similar group without bracing. Not bracing a child with scoliosis is the same as withholding treatment. It’s just not done in this country.

A recent expert panel on this topic was surveyed on the effectiveness of bracing. Today’s protocol suggests bracing should be done when a curve is 45 degrees or more. But when presented with 12 case studies to decide treatment on, there was a wide range of opinion among the panel. Some thought bracing would be very helpful. Others said it would be no use at all.

Studies on the outcomes of surgery after bracing don’t have clear results either. Results of these studies do not support bracing as being better than just observation.

What’s needed is a study that compares children with and without bracing. Up until now, that kind of study has been considered unethical. The reason is that not bracing a group is the same as withholding treatment. But the problem is, no one knows for sure that bracing really helps prevent a worsening of the problem. So how can it be unethical to withhold a questionable treatment?

We may see a comparative study sometime in the near future. Until then, many surgeons and parents agree to use bracing as a “just in case” measure. It may or may not prevent surgery later.

You may have to depend, in part, on your physician to help explain bracing as a treatment option for scoliosis. Right now, it is considered the standard of care for curves between 30 and 45 degrees.

Most children are treated for scoliosis, So it’s hard to compare results for patients with and without treatment. In fact, there are only two reported studies on the rate of surgery in patients who haven’t been otherwise treated for scoliosis.

Surgery rates were between 16 and 28 per cent. That’s about one in every three children. And we don’t know the predictive factors yet. Predictive factors are those things that, when present in a patient, suggest failure or success of a treatment.

The one predictive factor that has general agreement in the treatment of scoliosis with bracing is for girls. Female patients with scoliosis have a better result when bracing takes place before their first menstrual cycle. This doesn’t mean that bracing after menses begins can’t help.

We really need more studies to prove once and for all whether bracing does or doesn’t work and which patients get the best results. Until then, children and their parents should be given as much information and encouragement possible to give bracing a chance.

The use of minimally invasive arthroscopy for hip surgery is fairly new even in adults. Surgeons who attempted to use the same method for children found it difficult and frustrating.

Since then newer techniques have been developed. Better surgical tools have expanded the uses of arthroscopy in children. Now bone spurs and loose pieces of bone or cartilage can be removed from in and around the hip joint.

The first report of results from using arthroscopy with hip dysplasia was recently published. Three children had this operation after previous conservative care and surgery failed. The results were good with few complications.

More study is needed before minimally invasive arthroscopic surgery can be used routinely in the pediatric population. Complications and long-term results must be tracked and compared to the standard open operation currently used.

Scoliosis, or curve in the spine, is more common than many people realize. While we all have some curves in our back, about three out of 10 people have scoliosis. More girls have scoliosis than boys. It can run in families, or it can appear in one child in a family that has never seen it. If someone in your family has scoliosis, you or your children have a 20 percent chance of also having it. Children with certain physical disabilities can be more prone to developing scoliosis too.

If someone in your family has scoliosis, it’s a good idea to watch your children carefully and to advise your family doctor. Most scoliosis is only seen when children are between 10 and 14 years old because it develops slowly. If your doctor is watching for it, the curves may be caught early, helping treatment begin earlier.

Scoliosis can also appear in adults, although most often, it’s childhood scoliosis that wasn’t detected earlier.

If you’ve seen a child have a regular physical exam, you may have noticed the doctor asking the child to stand straight, feet flat on the floor, and then bend forward as if to touch the toes. The doctor is looking at the spine to see if it is bending forward straight, or if there is a noticeable curve. Other signs of scoliosis might be if a child has one shoulder or hip appearing higher than the other when standing straight, the waist doesn’t look even, or the child appears to be leaning to one side.

Spondylolysis is an injury that affects teen-agers who participate in repetitive sports or activities. If your child does compete in activities like gymnastics or football, for example, and is complaining about pain in the lower back that worsens with activity, but is better after resting, the doctor may be thinking about spondylolysis. Your child’s doctor will take a history, and ask questions like what types of activities your child enjoys, when the back hurts, and when it feels better. After that, the doctor will probably check your child’s posture, movement, and muscle strength. Based on this, the doctor may send your child for an X-ray.

Since spondylolysis is a fatigue or stress fracture, there are times that it might not seen on an X-ray. If your child’s doctor wants to follow up further before beginning treatment, he or she may order a bone scan or an imaging test. These tests can give a more accurate view of the vertebrae in the spine.

While doctors don’t agree on the specific treatment for this injury, they do agree that someone with spondylolysis needs to rest in order to heal. Their disagreement lies in how this rest should happen. Should he wear a brace that limits the back movements? Should she be told not participate in anything physical for a set amount of time? Is bedrest needed?

Your child’s doctor will use his or her own experience when deciding the type of treatment and take into consideration what type of a person your child is, and what caused the injury in the first place.