Scoliosis: Watch out for the curves
When Kathy Perkins saw her 12-year-old daughter, Nicole, in a bathing suit during the summer of 2000, she suspected something might be wrong with her back. Nicole's pediatrician confirmed her mother's fears by diagnosing scoliosis, a sideways curvature and rotation of the spine.
What causes scoliosis?
Diagnosing scoliosis
Treatment options
When surgery is the answer
What causes scoliosis?
Despite medical research, the most common type of scoliosis is idiopathic (cause unknown). And, while people of all ages can have scoliosis, adolescent girls — around age 10 — are most likely to be affected. "Idiopathic scoliosis usually appears without any warning or symptoms in healthy, active children," according to
Thomas O'Donnell, MD, chairman of pediatrics at Virtua Memorial Hospital. "While scoliosis may occur secondary to genetic or familial factors, any child should be considered at risk and should have a scoliosis check as part of a yearly physical."
Diagnosing scoliosis
The good news is that there is a painless and easy physical examination to detect scoliosis. The patient's back is examined to determine if the shoulders are level, the waist is symmetrical, the head is centered, and body sides are parallel. The patient also leans over so the examiner can see whether one side of the rib cage is higher than the other side.
Usually, scoliosis is detected during a school screening or annual physician checkup. The child may then see an orthopaedic spine specialist for further evaluation, which includes an x-ray of the entire spine. On the x-ray, the specialist measures the angle of the curve to determine its severity. Curves range from very slight (10 degrees) to severe (greater than 90 degrees).
Nicole's pediatrician diagnosed her problem. She was referred to
Suken Shah, MD, a Virtua/duPont pediatric orthopaedic surgeon who specializes in treating scoliosis.
Treatment options
Depending on the child's remaining growth and the magnitude of the curve, the physician develops an appropriate treatment plan. The overwhelming majority of children have small to moderate curves that simply require them to visit a doctor twice a year for observation.
Braces are recommended in growing children with curves around 25 degrees. Today's braces are smaller, made of flexible plastic and often undetectable under clothes. "The Wilmington braces are 80% effective at helping to stop a curve progress," explains Dr. Shah. "While the brace can help stop the curve where it is, the only way to correct a large curve is surgery."
Surgery is typically advised for curves that get to 50 degrees. "We want to get the curve under control. If left untreated, larger curves can cause deformity in appearance, back pain and — in extreme cases — compress the lungs and affect heart function," notes Dr. Shah.
Since Nicole's curve was over 50 degrees and progressing, bracing wasn't an option. After a second opinion, the Perkins family opted for surgery. Although they live in Lawrence Township, the family traveled to the Alfred I. duPont Hospital for Children in Wilmington for the procedure. "We were keen on using a duPont surgeon because of the institution's expertise in orthopaedics," comments Mrs. Perkins. "We have follow-up visits with Dr. Shah in Voorhees, which is convenient."
When surgery is the answer
The type of surgery depends on the location and severity of the curve. Usually, metal rods, hooks and screws are implanted to straighten the spine, create a solid fusion and remain in the patient permanently for stabilization. Patients generally stay in the hospital for less than a week. After surgery, braces or corrective casts are rarely needed because the implants used today are rigid and well fixed to the spine. "New surgical advances, such as minimally invasive approaches, show promise for the future," says Dr. Shah.
Each patient should discuss his options with at least two experienced orthopaedic spine surgeons. Virtua/duPont enables South Jersey families easy access to these types of specialists.
"They inserted two rods which completely straightened my back, with the exception of a minor curve at the top," says Nicole. "The most difficult thing was that for months afterward I wasn't supposed to bend over. If I even dropped a pencil at school, my friends had to come over and pick it up for me." A year after her operation Nicole is back to her full activity level, which includes swimming, biking and typical teen pastimes. She enthuses: "Now I can even go on the roller coaster and other rides at the amusement park."