When scoliosis develops in children before reaching adolescence, this is called ‘pediatric scoliosis’, and scoliosis diagnosed in adolescents between the ages of 10 and 18, with no known cause, is known as ‘adolescent idiopathic scoliosis’ (AIS). While adolescents, technically, are still in the pediatric phase of development, the way their bodies respond to the condition is very different from how it affects younger children; keep reading to find out how and why.
When it comes to understanding scoliosis in children, it’s especially important for parents and caregivers to know the signs to look out for, as well as the different forms that fit under the umbrella of pediatric scoliosis: infantile and early-onset juvenile. Adolescent idiopathic scoliosis (AIS) affects older children and is the condition’s most common form.
Before we move on to talking about the individual condition forms, I’d like to first explore the general topic of scoliosis progression, in the hopes of providing some clarity to an issue that many young patients and parents find unclear.
As a progressive condition, scoliosis is going to get worse over time, if left untreated, because it is in its nature to do so; this means that the abnormal sideways spinal curvature, with rotation, will get larger.
Scoliosis is classified as mild, moderate, or severe based on the size of the curvature. As a curvature gets larger, it can produce more noticeable symptoms such as postural changes.
Here at the Scoliosis Reduction Center, our goal is to be proactive in our treatment so our patients never have to deal with the hardships that come with reaching those higher stages of progression.
For young people and their parents and/or caregivers, the topic of scoliosis progression can seem very daunting, mysterious, and unclear. Understanding progression is important because treating scoliosis means effectively managing its progressive nature and trying to stay ahead of the condition’s progressive line.
To help people better understand this crucial aspect of scoliosis, I’ve put together some general progression-related topics that I think will help shed some light on the subject: age, skeletal maturity, gender, and curvature pattern.
As mentioned, progression is the big challenge we are facing with scoliosis treatment. As the condition is incurable, we have to do what we can to stay ahead of its progression; with some forms, that is easier than in others, but it is always a factor.
For children diagnosed with scoliosis at a younger age, most often, they are at a higher risk of curvature progression. This is because the biggest trigger for progression is growth and development.
The younger a patient is, the more growth and development they have yet to go through, which means there is a high likelihood that their curvature will increase as they grow and develop.
For children under the age of 10, a small curvature between 5 and 19 degrees has a 45-percent chance of getting bigger, but a curvature that measures between 20 and 29 degrees has an almost 100-percent of progressing.
Basically, as children get older, these percentages will likely decrease, but of course the operative word here is ‘likely’ because there is no hard-and-fast rule to accurately predict any patient’s rate of progression.
When a patient has reached skeletal maturity, this means they are no longer growing, and this is so significant for scoliosis because it means the big trigger for progression has been removed.
Now, to know approximately how much progression a child is facing would be akin to knowing exactly how much growth they have yet to go through.
Fortunately, there is a growth indicator that can help us predict this: the Risser sign.
The Risser Sign
A patient’s Risser sign is visible on their scoliosis X-ray images and looks to pelvic calcification levels to measure skeletal maturity.
This measurement tells us how much more a child has to grow, and in doing so, helps us predict their rate of progression.
Measured on a scale of zero to five, five being skeletal maturity reached in adulthood, the higher the Risser score, in most cases, the less likely a curvature is to progress.
When most people think of scoliosis, the image of a 16-year-old girl comes to mind; this is because girls are at a higher risk of progression than boys.
While the reason behind this is not fully understood, it’s thought that the higher prevalence of scoliosis progression in girls is due to the fact that girls mature faster than boys. They hit puberty earlier, meaning they have more growth and development to go through starting at an earlier age, and hormones could also play a role.
In fact, for curvatures larger than 30 degrees, girls are ten times more likely to go through scoliosis progression.
So gender can be another factor that helps us predict a young patient’s likeliest rate of progression.
In addition to age and gender, another factor that can help us predict progression is the pattern of the abnormal spinal curvature; some curvature patterns are more prone to progression than others.
There are three main sections to the human spine: cervical (upper back and neck), thoracic (middle back), and lumbar (lower back). While scoliosis can develop anywhere along the spine, thoracic curves, which also happen to be more common, are also more prone to progression.
Now that we’ve discussed some of the general characteristics that affect progression in children and adolescents, let’s turn our focus to facts about pediatric scoliosis and treatment that are important to understand.
In addition to gaining a better understanding of triggers for and patterns of progression, the following pediatric-scoliosis facts are important to address because they give a better understanding of treatment options and consequences.
Presently, we will touch on early diagnosis of scoliosis in children, surgery, lifestyle, and the two main treatment approaches.
While it’s always better to know what’s going on in the body sooner rather than later, when talking about progressive conditions, it’s especially important and beneficial to catch the condition early on.
Reaching a diagnosis early means being aware that the condition has developed and being able to proactively respond.
As mentioned earlier, the goal is to catch conditions as early as possible so we can reduce the curvature and control its progression.
Now, early detection is important for treatment success for scoliosis patients of all ages, but for patients under the age of 10, this is particularly so. This is why it’s so important for parents and caregivers to be aware of the signs to look for so there is potential for reaching an early diagnosis.
While every condition produces its own unique symptoms and characteristics, there are some common signs to watch out for in children, and these include postural changes such uneven shoulders and/or hips.
Even the most common of symptoms can be very subtle in mild conditions, which is why as beneficial as early detection is, it’s not always the easiest to accomplish. Not only are children far less likely to notice changes in their body (after all, they are growing and changing all the time), but it’s also very rare for children with scoliosis to experience pain related to their condition.
The above factors mean that, quite simply, it’s up to the parents and caregivers to look for and notice early indicators of scoliosis.
Also, when talking about adolescent idiopathic scoliosis, we are talking about adolescents and teenagers who are even less likely to share changes they might be noticing in their bodies. As parents of this age group are no longer bathing and dressing their children, the opportunities to notice the subtle changes that scoliosis can produce in children early on start to dwindle.
Early detection allows us to come up with a customized treatment plan with the highest chance of efficacy. As scoliosis is progressive, especially in patients who have not yet reached skeletal maturity, the sooner treatment is started, the better.
That being said, even with early detection, no one can guarantee positive treatment results; progression can still happen very quickly despite active treatment, but generally speaking, early detection can have a huge impact on treatment success.
When scoliosis is diagnosed in children prior to their first big growth spurt, there are far fewer limits to what we can do.
Staying physically active is important for anyone and everyone, but for people living with scoliosis, this is especially true.
When it comes to children with the condition, sports, exercise, and physical play are essential.
Juvenile patients who don’t engage regularly in physical activity run the risk of losing strength and mobility over time, and this can have a huge impact on how their body responds to treatment.
We need the spines, and surrounding muscles, of our young patients to stay as loose and flexible as possible so their curvature is more responsive to treatment.
Regular exercise is also linked to bone-density levels, which makes the body’s skeletal system stronger and healthier overall.
As we also know that girls are more likely to develop conditions of the skeletal system like osteoporosis, and are also at a higher risk of scoliosis progression, parents and caregivers should be especially encouraging of an active lifestyle for their female children.
Now, let’s move towards the two main scoliosis-treatment approaches that parents and caregivers have to choose between: traditional and functional.
For parents and caregivers of children recently diagnosed with scoliosis, knowing where to go from there can be overwhelming, especially as this choice has the potential to affect how that loved one experiences life with their condition.
While the traditional approach to scoliosis treatment is unlikely to recommend surgery for their juvenile patients, this approach does still funnel patients in that direction.
When scoliosis is diagnosed in a child, the traditional response is very cautious and based on passive observation. Most often, this would involve monitoring the condition to see its rate of progression and conducting examinations at regular intervals.
This approach, however, is risky as young patients can have a huge growth spurt in between those scheduled examinations, and then suddenly, that patient has progressed significantly to the point where they are in a whole different stage of severity.
Traditional bracing is sometimes used, such as the Boston brace, but this is used in an attempt to slow/stop progression and doesn’t have correction as its end goal.
The traditional model of treatment for children involves a lot of biding time until a curvature progresses to the point where recommending surgery becomes justifiable.
Surgery is invasive and comes with a lot of risk factors, not to mention the fact that there is a lack of research on long-term effects.
Surgery and Pediatric Scoliosis
When it comes to children living with scoliosis, I feel it’s particularly important to help them avoid spinal-fusion surgery as their spines are still growing.
Juvenile early onset scoliosis that occurs between the ages of 3 and 10 carries a high likelihood of progression because this age group has so much growth yet to go through.
Even those who support surgery as a scoliosis treatment option rarely recommend it for individuals that young. Most view surgery for adolescents as an option once they have gone through those first major growth spurts.
Scoliosis surgery performed on patients who are too young can stunt growth and result in the need for more surgeries, which is never a good thing.
Fortunately, there is another treatment approach available whose goal is to do everything possible to help these young patients avoid the operating table.
A functional approach to scoliosis treatment is what we offer our patients here at the Center. It’s an integrative approach that’s characterized by action, instead of observation as in the traditional approach.
We combine multiple treatment disciplines so we can fully customize treatment plans to address the unique variables of each patient and their condition.
We want to help our young patients avoid needing scoliosis surgery later in life, so we want to start active treatment as close to the time of diagnosis as possible. We don’t feel the need to watch and wait to see how a condition progresses; it’s enough that we know it’s virtually guaranteed to do so.
We don’t waste valuable treatment time, we act. That action involves combining scoliosis-specific chiropractic, therapy, corrective bracing, and rehabilitation.
Based on my experience, even for juvenile patients, this approach can be highly effective.
For children, treatment can be a challenge, and it can be a long road ahead for them and their families. The younger a patient is, the harder it can be because, of course, they won’t necessarily understand the ‘why’ and ‘how’ of what we are trying to accomplish.
For adolescent patients, we engage them in the treatment process, and this has huge benefits in terms of treatment efficacy and mental health. It’s good for these young patients to be able to gain some feelings of control they may have lost with their diagnosis.
With our chiropractic-centered approach, we have helped countless young patients avoid costly and invasive surgical intervention.
Now, let’s spend a little time discussing some of the main forms of scoliosis in children and how they develop
As mentioned, scoliosis can develop at any age.
When it comes to scoliosis in children, the umbrella term ‘pediatric scoliosis’ covers infants and juveniles as they have developed the condition before reaching adolescence.
As there is such a high prevalence of scoliosis in adolescents and they experience the condition so differently, we tend to focus on adolescent idiopathic scoliosis as its own category.
The ‘infant’ category would include young patients between the ages of 0 and 3. This category can refer to cases of infantile idiopathic scoliosis or congenital scoliosis, which develops in utero.
In infantile idiopathic scoliosis, it’s etiology is unclear; in congenital scoliosis, there is an inability of the bones of the spine (vertebrae) to form properly.
In a healthy spine, the vertebrae are rectangular in shape, are stacked on top of one another, and are separated by intervertebral discs.
When one of those vertebrae are malformed and are triangular in shape instead, this can cause the spine to slip out of alignment and scoliosis to develop as a result.
While there is some data showing small curvatures in infants can sometimes resolve themselves, there is no way to know which ones will improve on their own and which ones will progress, which is why it can still be so important to act.
In these types of cases, treatment most often is a modified version of treatment we would implement for older children and teenagers, and this would likely combine scoliosis-specific therapy and corrective bracing.
As mentioned earlier, early-onset juvenile scoliosis affects children between the ages of 3 and 10.
As this age group is at a particularly high risk of progression, because they have so much growth yet to go through, without active treatment, these patients are very likely to experience progression throughout childhood and well into adulthood.
Individuals with the most growth ahead of them are at the highest risk of progression because, as we know, growth and development is the big trigger for curvature progression.
That is why seeking out active treatment is so important.
Adolescent idiopathic scoliosis is the condition’s most common form; it accounts for 80 percent of known diagnosed scoliosis cases and affects individuals between the ages of 10 and 18.
As the ‘idiopathic’ classification means there is no single known cause, we don’t fully understand how this form develops. The general consensus is that the condition is multifactorial, meaning caused by a combination of factors that can vary from person to person.
We know that girls are more commonly affected and are more likely to experience progression than boys, and we also know that treatment started early has better chances of success.
Our functional approach is about prevention and correction. We combine disciplines, apportioning them accordingly, based on how we see a patient’s spine responding to treatment.
We don’t want to just slow down progression; we want to impact the condition on a structural level by achieving a curvature reduction. By doing this, we are staying ahead of its progressive line and avoiding the hardships associated with further stages of progression.
When I see scoliosis in children, I take it very seriously and want to do everything right. This is because if we address childhood scoliosis properly, we have the potential to impact the rest of their life.
While most discussions of scoliosis in children tend to center around adolescents, as they most commonly develop the condition, younger children can develop it as well.
Infantile scoliosis affects children between the ages of 0 and 3, and this form can be idiopathic or congenital, meaning the condition either has no single known cause, or it developed in utero due to a vertebral malformation of the spine.
Juvenile scoliosis refers to children with scoliosis between the ages of 3 and 10, and this age group is at a high risk of progression because having not yet reached skeletal maturity, they are facing a lot of growth and development, known to trigger the condition’s progressive nature.
Adolescent idiopathic scoliosis is the condition’s most common form and affects individuals between the ages of 10 and 18. This age group is entering into, or going through, the stage of puberty, marked by rapid and unpredictable growth spurts.
Adolescents make up the majority of my patients, and together, we work closely to achieve a curvature reduction by addressing the structural nature of the condition.
These different forms of scoliosis in children appear at different ages and have different characteristics based on some of the factors we discussed: age, skeletal maturity, gender, and curvature pattern.
While there are never guarantees when it comes to scoliosis-treatment outcome, early detection has huge benefits in terms of treatment efficacy.
With scoliosis in children, the onus of noticing early signs of the condition falls mainly on the parents and caregivers, which is why it’s so important to be aware of the benefits of early detection and the early signs to watch out for.
Here at the Scoliosis Reduction Center, I’ve treated patients of all ages, but when it comes to treating scoliosis in children, this is where I really like to make my mark as there is the potential to change the course of their entire lives moving forward.