Scoliosis
Paediatric Scoliosis is a medical condition that causes an abnormal curvature of the spine in children and adolescents
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What is Scoliosis?
Scoliosis is a condition in which the spine has a sideways curvature and is most often diagnosed during adolescence.
The spine is made up of multiple bones (vertebrae) that are connected to cartilage, which provides the flexibility to bend, stretch and balance. Scoliosis occurs when the vertebrae form an ‘S’ or ‘C’ shaped line instead of being straight.
Scoliosis is divided into three categories:
Congenital Scoliosis: This type occurs when a person is born with a spinal curvature due to abnormalities in the formation or separation of the vertebrae during fetal development.
Neuromuscular Scoliosis: This form results from a range of neurological or muscular conditions, such as cerebral palsy, Duchenne muscular dystrophy, and myelomeningocele (spina bifida). Each of these underlying conditions requires specific treatment approaches, which differ from those for adolescent idiopathic scoliosis.
Scoliosis Treatment
In the constantly evolving world of spinal deformities, Dr Gary believes that the primary focus for mild scoliosis is non-operative. To this end, Gary works alongside a trusted team of expert physiotherapists and orthotists to address a child’s spinal condition.
In many cases, scoliosis is mild and can be observed with no intervention; however, if left unmonitored, the spinal curves can worsen as your child grows.
When surgery is deemed necessary, there are many options depending on curve type and severity, as well as the patient’s age and any underlying medical conditions.
Dr Gary is qualified in a broad range of surgical options, including posterior spinal instrumentation, anterior scoliosis surgery, ‘growing’ rods and vertebral body tethering (VBT).
Scoliosis Treatment Options
When it comes to scoliosis, treatment is not one-size-fits-all. Each case is unique and should be tailored to the individual, taking into account factors like age, symptoms, and the results of their radiology. Fortunately, not everyone with scoliosis requires treatment, many people with mild curvatures live without any specific interventions, especially if their condition isn’t progressing.
Larger curves in younger children are more likely to worsen over time, so understanding the key factors that influence progression is important. These include the severity of the curve, the patient’s gender (as females are more likely to experience progression), their stage of growth (as progression is less likely once bones stop growing), and the location of the curve, with thoracic curves being more prone to deterioration than others.
By accurately predicting how the condition may progress, Dr Gary can make better-informed decisions about how to manage scoliosis, particularly in children and adolescents.
Depending on the severity and age of the child, different approaches may be considered:
Casting
For young children under 6, a plaster cast can be applied under general anaesthetic to help straighten the spine. The cast is typically worn for 6 weeks, and some children may need several casts in succession.
Bracing
Non-surgical treatment for scoliosis often involves bracing, where a custom-made external brace is worn for 2-3 years to prevent the curve from worsening. Bracing is most effective while the spine is still growing. Although it doesn’t cure or reverse the curve, it typically prevents further progression. Made of plastic, braces fit snugly under clothing, extending from under the arms and around the ribs, lower back, and hips. While wearing the brace day and night, children can usually continue most activities with a few restrictions, and the brace can be removed briefly for sports.
Surgery
If bracing is not effective, surgery may be required to stabilise the spine and prevent further curvature. This typically involves internal fixation to maintain proper spinal alignment. Dr. Gary will discuss the most appropriate surgical options based on your child’s specific condition.
Symptoms of Scoliosis
The most noticeable symptom of scoliosis is an abnormally curved spine. Early signs can be subtle and may go unnoticed until the curve becomes more pronounced. In many cases, family members, friends, or sports coaches may be the first to spot the asymmetry in the spine.
Scoliosis can range from mild to severe, and the symptoms may include:
- One shoulder tilted down towards a raised hip, making the child appear to lean sideways
- Prominent ribs or rib asymmetry
- A protruding shoulder blade
- A tilted waist
- The curve becoming more pronounced when the child bends forward
These signs often develop gradually. As the condition progresses, the curve becomes more noticeable, particularly when the child bends or moves.
Risk Factors
If scoliosis is left untreated, the curve may worsen over time, especially during the growing years. In some cases, pregnancy can cause the curve to increase. This can lead to chronic pain, deformities, and spinal arthritis. Early detection and treatment are crucial to avoid long-term complications.
Diagnosis
Scoliosis is diagnosed through a combination of X-rays and a thorough physical examination.
During the assessment, several factors are considered, including:
- The shape of the curve (e.g., ‘S’ or ‘C’ shape)
- The location of the curve (upper back, lower back, or both)
- The direction of the curve (leaning to the left or right)
- The angle of the curve
For more information on how to detect scoliosis, view the Scoliosis Australia Detection Fact Sheet: How to Detect Scoliosis: Information for Adolescents Aged 10-14 Years and Their Parents.
Quick Facts About Scoliosis
Cause
Unknown/ Genetics
Signs/ Symptoms
‘S’ or ‘C’ curved spine, Asymmetry in shoulders or hips
Treatment
Brace/Surgery
Treatment Process
Easy/Moderate (TBC)
Recovery
Brace N/A/ Surgery 12 months
Covered under Medicare?
Yes, select patients may be eligible
Download Scoliosis Fact Sheet
For more information, download the Royal Children’s Hospital Melbourne Scoliosis Fact Sheet.
Scoliosis FAQs
Although the exact cause is often unknown, it is helpful to divide Scoliosis into the following categories
- Idiopathic Scoliosis: meaning the cause is unknown (although there is often a genetic predisposition)
- Congenital Scoliosis: here the spinal vertebrae have not been formed correctly in-utero
- Neuromuscular conditions: where there is an underlying condition such as cerebral palsy, muscular dystrophy, neurofibromatosis etc
Scoliosis is relatively common and affects 2-3% of the population. It is more prevalent in females and usually appears between 10-13 years of age.
Symptoms of Scoliosis include
- Asymmetry in the shoulders or hip
- Uneven or twisted waistline
- One side of the chest having ribs that stick out more prominently than the other
Ideally if detected early and depending on the severity, it may be appropriate for your child to be fitted with a Scoliosis brace. If the brace is deemed unsuccessful, surgery such as VBT, posterior spinal instrumentation, anterior scoliosis surgery, or ‘growing’ rods may need to be undertaken.
If left untreated, Scoliosis can worsen with age. The rate and degree of progression can vary depending on the type of Scoliosis, and the location of the curve.
Speak to our friendly team
Not all conditions and symptoms are alike. If you have a concern about your child’s wellbeing or would like to direct questions to Gary Nattrass you may contact our friendly team on 03 9322 3360.
We will gladly take your call and assist you with your enquiry.