While curvature and rotation of the spine doesn’t sound like it would be normal or common, as many as 9 million people in the U.S. are affected by it. It’s called scoliosis, which is apparent when an “s” or “c” shape is seen in the spine.
Scoliosis is most commonly diagnosed by pediatricians during annual checkups. “Curvature of the spine is something that is related to growth and development most of the time,” said Dr. Sumon Bhowmick, a pediatrician with Novant Health Waverly Pediatrics & Primary Care. “For the majority of teenage and ‘tweenage’ kids," it does not present a health problem or require treatment.
More severe types of scoliosis can be caused by injury or fractured bone, as well as by developmental, metabolic or congenital issues seen at very young ages, sometimes before birth.
But, Bhowmick said: “Scoliosis, by and large, is pretty benign. It’s something we can manage. It’s something that, as you continue to grow and develop, self-corrects a vast majority of the time.”
Here’s what to know about that more common type of scoliosis related to growth and development.
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“Around the end of that elementary and middle school age is when we keep our eyes open for symptoms of scoliosis,” Bhowmick said. “The vast majority of these kids have idiopathic (meaning the cause is unknown) scoliosis, which is just something that we find while we’re doing our exam, or while we’re talking, or if they’re playing sports, or if they’re having any kind of nonspecific symptoms (like back pain). We’ll check that out on a routine basis.”
“The problem is the possibility for it to worsen or for the curvature to become even more angulated,” Bhowmick said. “The way that we try to avoid that is by checking it routinely through annual exams. We try to determine if they’re having any issues with pain or posture or misalignment.”
Most of these kids won’t experience symptoms, he said, and the progression of a minor scoliosis isn’t very common.
“Even though the incidence for boys and girls getting scoliosis is pretty much the same, it’s almost 10 times more likely for a girl to have scoliosis become more severe,” Bhowmick said. “That might have to do with how early they grow. Girls typically grow first; boys grow the most.”
Family history can be a reason for more watchfulness, too. Children with tall family members or a family history of spine issues or scoliosis can also be more at risk.
“Typically if we have a concern about it, we’re going to take an X-ray,” Bhowmick said. “When we take an X-ray, we get something called a Cobb Angle, basically using parallel lines to determine exactly what angle of curvature we’re talking about. Anything more than a 10-degree curvature is what’s considered to be more problematic and it could become more curved down the road.”
If curvature is getting worse over a couple of years, or more symptoms are arising, like chest pain, back pain or difficulty breathing, Bhowmick would refer that child to an orthopedist or physical therapist.
An orthopedist will see a range of patients, from those with slight curvature to those who need treatment for more severe curvature, depending on a pediatrician’s recommendation. It’s all based on degrees of curvature, said Dr. Phillip Mason, an orthopedic surgeon with Novant Health Orthopedics & Sports Medicine - Winston-Salem.
At 10-25 degrees: “We usually watch,” Mason said. They live life and return in six months for a repeat X-ray.
At 25-40 degrees: “If the kid is still growing, we think about a back brace,” he said. “The back brace works by giving some gentle, temporary correction to the curve with the goal of keeping the curve where it is.” The child would use this until they’re done growing.
Over 50 degrees: “We think about surgery,” he said. “It’s not that common, but it is done.” Most of the time, surgery would involve a posterior spinal fusion to straighten the spine through a system of screws and rods.
DNA definitely can play a major part, but posture, stretching and building muscle through bodyweight exercises can be beneficial. “Being active just from play is important,” Bhowmick said. Being less active or overweight, he added, can increase the likelihood of problems to occur.
Hydrating, resting and eating nutritiously are also key steps in prevention – “basic stuff that we would tell anybody, regardless of scoliosis concerns,” Bhowmick said. “Those things play a role and permeate everything that we do when it comes to being healthy, and scoliosis is no exception.”