Scoliosis is a condition characterized by an abnormal lateral curvature of the spine that makes the spine appear as an “S” or “C”. It can occur at any age and is seen more frequently in girls than boys.

Early onset scoliosis

Early-onset scoliosis is the abnormal lateral curvature of the spine that occurs in children who are less than 5 years old. This condition includes children with congenital scoliosis (present at birth) and infantile scoliosis (birth to 3 years). Early onset scoliosis is associated with congenital chest deformities, neuromuscular disorders such as cerebral palsy, muscular disease, and tumor. It generally affects boys more often than girls.

There is no known cause for early onset scoliosis. It does not cause any pain, but it may affect your child's overall appearance.

Your doctor identifies the condition by performing ‘Adam's forward bend test’. During this test, your child is asked to bend forward and your doctor observes the symmetry of the hips and shoulders, and the curvature of the spine from the sides, front and back. An X-ray of the spine is ordered to measure the degree of severity of curvature. An MRI scan of the entire spine is often recommended to detect any neurologic changes.

Treatment of scoliosis is based on the physician’s assessment of the spinal curve, its cause, the age of the child, and expected growth of the child. Treatment options include non-surgical and surgical treatment. Non-surgical treatment consists of observation, bracing and casting.

  • Observation: The child is examined every 3 to 4 months to monitor the curve. If your child's curve is progressing, then additional treatments may be required.
  • Bracing: Your doctor may recommend wearing a brace to prevent worsening of the curve. Braces do not treat the condition, but it helps to slow the progression of the curve. However, bracing is not effective in neuromuscular scoliosis and congenital scoliosis.
  • Casting: A cast is applied to your child’s trunk to control and correct the curve by allowing the spine to grow in a normal manner. The cast is changed regularly until the curvature is reduced.

If these conservative treatments do not control the curve, your doctor may suggest surgery. Children who are at a risk of developing respiratory and cardiac problems because of the progression of the curve may be recommended for surgery. Surgical modality includes insertion of implants such as growth rods, vertical expandable prosthetic titanium rib prostheses (VEPTR), and spinal staples. These implants help in correcting the curvature without interfering with the growth of the spine.

Growth rods are expandable devices that are attached to the top and base of the spine with the help of internal fixators such as screws and hooks.

Vertical expandable prosthetic titanium rib prostheses are artificial devices that are placed between your child's ribs to move them apart. It straightens the spine and increases the space for the lungs and improves pulmonary function.

Spinal stapling is a minimally invasive technique that involves implanting metallic staples across the growth plate of the spine. This procedure modulates growth and corrects the curve without a spinal fusion procedure.

Idiopathic scoliosis

The exact cause of idiopathic scoliosis is unknown in most of the cases. There are three types of idiopathic scoliosis based on the age of occurrence.

  • Adolescent idiopathic scoliosis: most common type that occurs after the age of 10 years
  • Infantile idiopathic scoliosis: occurs in children below 3 years and may be present at birth (congenital), or associated with various syndromes or neurologic disorders
  • Juvenile idiopathic scoliosis: uncommon and occurs in children between the ages of 3 and 10 years.

Idiopathic scoliosis does not cause any pain, nerve dysfunction or breathing problems. The child’s overall appearance will be the main concern.

Your doctor will perform Adam’s forward bend test to check if any deformity is present. Your child is requested to bend forward and the spine is examined for curvature. The diagnosis is then confirmed with an X-ray, where the curvature is measured.

The treatment of scoliosis is important because if left untreated, the curves measuring more than 50° may cause long-term problems such as a decrease in lung capacity, leading to restrictive lung disease. The choice of treatment is based on the degree of the scoliotic curve, the child’s age and the time period remaining for the child to reach skeletal maturity.

Nonsurgical treatment

  • Observation: If there is only a mild curve (less than 20°) or if the child is nearing skeletal maturity, a regular check-up every 3-6 months is sufficient.
  • Bracing: Bracing is done to prevent the progression of scoliotic curves. It is effective in growing children with a spinal curvature between 25° and 45°.

Surgical treatment

Surgical treatment is recommended in cases where the curve is greater than 45° and in those who have reached skeletal maturity having scoliotic curves that exceed 50° to 55°. During surgery, an implant made up of rods, hooks, screws or wires is used to straighten the spine. Bone grafts, obtained either from a bone bank or the patient’s own hip region, may be used to promote healing.