Guest Author - Gwenn Schurgin O'Keeffe, MD, FAAP
Your pre-teenager’s school calendar has “scoliosis screening” scheduled for the following week. You take a quick look at your child’s spine which looks nice and straight to you so you put the issue out of your mind. Imagine your surprise when you receive a letter from the school informing you that your child’s back screen revealed some signs of scoliosis that should be investigated further by your pediatrician. But, you are not convinced – your child’s back looks fine to you. You can’t help but wonder if a lot is being made of nothing. Do you really need to pursue this?
It turns out that you are right – and wrong – all at once. Most scoliosis will not impact your child’s life at all; however, there are some cases of scoliosis that develop into something much more severe – and that’s why catching it early is so important.
Our spines are made to curve naturally front to back in the neck and lower back to help support our body on our pelvis and to keep us upright. But some backs develop curves sideways. Scoliosis is the term used to describe these abnormal curves. While scoliosis can run in families, it doesn’t have to. Scoliosis can develop at any age but the vast majority of scoliosis occurs just before puberty when growth begins to accelerate. 80% of scoliosis is “idiopathic”, which is medical short-hand for cause unknown. Rarely, some kids will have an underlying neurologic, muscular, or genetic disorder causing the scoliosis but those kids usually have other medical issues as well. The amount of boys and girls who are diagnosed with scoliosis is the same but girls tend to get the more progressive type.
Most idiopathic scoliosis is mild and requires little treatment beyond observation. But progressive scoliosis is a different story and left untreated can cause many problems in adult life such as deformity, chronic back pain, breathing difficulty and neurologic problems. School screening allows for early identification of scoliosis to intervene well before problems develop and when many treatments options still exist.
Most states now have school screening programs for scoliosis including Massachusetts and all target the preteen and early teen years. The school scoliosis examination most often used is the Adam’s Forward Bend Test which looks for unevenness in the back with one side being higher than the other. Kids backs are also looked at for other signs of possible scoliosis: uneven shoulder or hip heights or a shoulder blade looking prominent. Keep in mind that these findings are only suggestive of scoliosis. Only an xray can truly diagnose scoliosis and define the extent of the curve. The greater the curve, the more severe the scoliosis.
Should a school nurse detect a feature that may suggest scoliosis, you’ll be informed – usually by a letter. If this happens to one of your children, call your child’s pediatrician to arrange a more formal evaluation. In addition to a repeat physical examination of your child’s back, your child will likely obtain an xray to confirm if a curve is present and to what extent. If scoliosis is indeed present, your pediatrician can explain to you what sort of treatment is needed, if anything. Children with curves that require more than observation are usually referred to an orthopedist.
Luckily the vast majority of scoliosis is mild and without later consequences. Mild curves, less than 20degrees, are usual managed by observation and rechecks every 3-6 months until the child stops growing. This is the most common scenario picked up by school screens. For more serious curves or progressive curves, bracing and surgery may be needed. An orthopedist can help guide the treatment option best for your child should your child’s scoliosis fall into this category.
Scoliosis screening is a wonderful way to introduce our kids to the idea of screening in general and the importance of good health monitoring to catch potential issues before they become problems. We need our backs to do most everything in life. You can help your kids understand why back screens are so important by explaining to them that if they do truly have scoliosis, later in life they may have trouble doing the activities they love today. That to me is worth not only the disruption in our kids’ school day but the risk of a false alarm.