Early-Onset Scoliosis: Abnormal Spinal Curvature In Children

In its simplest form, scoliosis is an abnormal curve of the spine.

When you look at someone’s back, their spine usually runs right down the middle. In people with scoliosis, though, you’re likely to see the spine curve to one side, usually in the shape of a “C” or an “S,” the National Institutes of Health says. Most people with scoliosis, including children, don’t need treatment, although they certainly benefit from routine visits to the doctor for an occasional check-up.

Severe spinal curvatures, however, can lead to long-term complications, especially when the disorder is diagnosed in young children.

Types Of Scoliosis In Children

What causes scoliosis? Surprisingly, most cases of scoliosis go unexplained, and are thus labeled “idiopathic,” which is doctor-speak for “we don’t know.”

Researchers are still working to understand the disorder, although there does appear to be a genetic component. Scoliosis seems to run in families, the Scoliosis Association reports, so we can suspect that, at least in part, the condition is hereditary.

Congenital

A minority of scoliosis cases develop long before a child is born. These “congenital” cases begin when a child is still developing in the womb. For some reason, the bones from which the spine is formed, known as vertebrae, don’t form properly. In some children, one or more of these bones will fail to form entirely, causing further abnormal spine growth after the child is born.

Syndromic

A syndrome is a collection of symptoms that often accompany one another. Most syndromes are genetic in origin, where a genetic mutation leads to multiple complications. Several genetic disorders include scoliosis as a potential symptom. Trisomy 21 (Down syndrome) and Marfan’s syndrome are notable examples.

Neuromuscular

Some neuromuscular disorders, including Duchenne muscular dystrophy, impair the function of nerves that stimulate the spine. Over time, this nerve impairment can lead to abnormalities in the spinal curvature, including scoliosis.

Other Forms Of Spinal Curvature

When physicians talk about scoliosis, they’re only discussing disorders in which the spine is curved sideways. To describe other forms of spinal curvature, doctors use the terms “lordosis,” which refers to a spine that curves inward at the bottom, and “kyphosis,” a spine that curves inward at the top, rounding the shoulders.

Early-Onset Scoliosis

Scoliosis usually appears in children between the ages of 10 and 15 years old. Why? That’s when most children undergo one or more growth spurts, WebMD reports. As the body develops, abnormalities already present in the spine usually become more pronounced, obvious to both children and their parents.

However, some severe spinal deformities are present long before the age of 10. When scoliosis develops before the age of 10, physicians call it early-onset scoliosis, or EOS.

You might also see the terms infantile scoliosis and juvenile scoliosis used in the medical literature. As the British Scoliosis Society notes, all of these phrases refer to the same medical condition.

Early-onset scoliosis is a serious medical condition. In general, the earlier a severe scoliosis begins, the worse it will become. And continued physical development will only enhance the curvature already present in the spine.

Complications Of Early-Onset Scoliosis

Severe curves, in short, will get larger. That can be a major problem, as we’ll see in a moment. It can also have major implications for treatment.

When doctors diagnose early-onset scoliosis, which can only be diagnosed in children under 10, they tend to suggest treating the condition, rather than waiting to see what will happen. Now we know why. Kids under the age of 10 still have a lot of growing ahead of them. So does the curvature in their spine.

Lung & Nerve Damage

Left uncorrected, a severe spinal curvature can begin to jut into spaces where other organs are growing. Lung development is often impaired in cases of severe scoliosis, since the curve in the spine is crowding out vital organs. As a result, some children will experience breathing difficulties, alongside pain and aches. These complications are most likely to occur in children with early-onset scoliosis, since the lungs, like the spine, are still developing during early adolescence.

Worsening scoliosis can impact the spine in more fundamental ways. As the vertebrae become increasingly compressed, normal daily motion can force the bones into grinding contact, which in turn can lead to chronic pain disorders. Nerve damage is another concern.

Scoliosis Signs & Symptoms

Beyond the obvious effect scoliosis can have on a child, parents usually begin to notice something different about their son or daughter’s posture. As your child grows, carefully note the relationship between their body parts when they stand or sit. In cases of scoliosis, a number of abnormalities should become apparent over time:

1. Children with scoliosis often have an imbalance in the height of their shoulders or hips; one side seems to be higher than the other.
2. In some kids, one shoulder blade sticks out more than the other, an abnormality that becomes even more apparent when the child bends over.
3. The ribs on one side may seem to sit higher than on the other side. This might be most obvious from the back.
4. The effects of scoliosis often extend down from the spine to the hips. As the spinal curve alters the child’s posture, one hip can appear to thrust outward, while the other side is flat.
5. The spinal curvature can also change where the head sits above the body. The head will sometimes tilt to one side or the other, as if the child is leaning, rather than being centered over their torso.

Many children are initially diagnosed by a school nurse. Schools have performed mandatory scoliosis screenings for decades. To confirm the diagnosis, a doctor will perform a physical examination to evaluate the spinal curvature. X-ray, MRI or CT scans can help physicians gain a clearer understanding of the curve’s extent and potential treatment options.

To determine the severity of the condition, physicians calculate the spine’s Cobb angle, a measure that represents the degree of curvature. Curves with a Cobb angle below 25° generally don’t require any treatment other than careful observation, according to MedicineNet.com.

How Is The Condition Treated?

The vast majority of “idiopathic” scoliosis cases are mild, the Mayo Clinic says. Mild cases of scoliosis tend to resolve of their own accord; the spine straightens out as the child continues to develop physically. Checkups to evaluate the curvature are necessary, but most patients will simply outgrow the condition. That’s not true when it comes to severe curves.

Orthopedic surgeons usually choose to intervene when they believe the spinal curvature will progress without treatment. The decision to treat scoliosis, or watch and wait, is made on an individual basis, experts at the Mayo Clinic continue, depending on a range of unique patient characteristics:

• Sex of patient – Scoliosis is nearly 10-times more likely to progress in girls than in boys, according to researchers in the American Family Physician.
• Curve pattern – In general, “C”-shaped curves are less likely to worsen than are “S”-shaped curves.
• Curve location – Curvatures at the middle of the spine usually progress more than ones at the bottom or the top of the spine.
• Curve severity – Smaller curves are less likely to worsen than large ones
• Skeletal maturity – How developed is the child’s skeleton? After spinal growth has ended, the curve is unlikely to worsen.

When a young child is diagnosed with severe scoliosis, specialists are faced by two basic options: bracing or surgery. Bracing is generally preferred, because it’s non-invasive. In less-severe cases, a plaster cast or brace can be fitted for the patient’s torso to promote straighter spine growth. Unfortunately, bracing has a low success rate when a child’s Cobb angle is above 40°.

Surgery To Correct Spinal Curves

In severe cases, surgery is usually the final option to consider. The traditional surgical method for early-onset scoliosis involves implanting one or two “growing rods” into a child’s back. Running alongside the spinal column, the rods extend from the top to the bottom of the abnormal curve and hold the spine straight.

Traditional growing rods are highly effective, the Scoliosis Research Society notes. Just the first implantation procedure can, in most cases, correct a child’s spinal curve up to 50%. But since the child is still growing, their rods will need to be lengthened occasionally.

Traditional implants have to be extended (or “distracted”) manually, which means another invasive surgery. According to Boston Children’s Hospital, the average patient will undergo another distraction procedure every six to eight months. Over the course of a full treatment, some kids will endure more than 20 surgical operations.

Is The Magec System A Miracle For Kids?

A newer invention hopes to change all that. Manufactured and marketed by San Diego company NuVasive, the Magec System features an innovative sort of growing rod that relies on magnetic technology, rather than manual distraction, to lengthen inside a patient’s body. After implantation, the rods “magically” extend of their own accord, after being activated by a surgeon using the company’s external remote control.

Don’t jump to call the Magec System a miracle just yet, though. While early results on the revolutionary technology’s efficacy were promising, a series of new medical reports have pointed to some potential problems. A number of recent studies have linked the implant to reports of metallosis, a form of tissue death associated with metal implants, and other serious complications.