Four medical groups say schools should check preteens for scoliosis

Four medical groups say children should be screened at school for scoliosis, an abnormal curve of the spine that can cause problems if severe cases go untreated.

The sideways S- and C-shaped spines that mark scoliosis can occur in both girls and boys. The most common form of the problem appears after age 10.

Girls reach adolescence about two years earlier than boys. Girls also need treatment for scoliosis three to four times more often than boys. Medical groups suggest girls should be screened twice, at ages 10 and 12, and boys once, at age 13 or 14.

“Untreated, scoliosis can progress in some cases. This can lead to physical deformity, and severe cases may even compromise overall function and cause breathing problems,” says Jochen Son-Hing, MD, pediatric orthopaedic surgeon, UH Rainbow Babies & Children’s Hospital. “Scoliosis usually causes children no pain. It can run in families, so there’s often a genetic component, but the overall combination of factors that causes scoliosis is still poorly understood.”

Scoliosis Screenings and Treatment

A trained professional screens children with a visual examination of the back to see whether the spine shows any signs of a sideways curve. A normal spine should look like a straight “I.” A screener who sees a curve refers the child to an orthopaedic surgeon for more tests.

Experts have been split on whether screening at school is effective from a medical and cost viewpoint. A task force of the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics, the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America has drawn up recommendations.

Guidelines for management of scoliosis include the following:

• Observation is appropriate when the curve is mild or the child is near skeletal maturity.
• Bracing can decrease progression of scoliosis. Orthopaedic surgeons consider bracing when a child is still growing and has a spinal curve of 25 to 40 degrees.
• Surgery is an option when the curve is more than 45 degrees, whether or not the child is still growing.

When the Curve Is Too Great

In severe cases of a spinal curve, orthopaedic surgeons at UH Rainbow Babies & Children’s Hospital have achieved milestones for advanced surgical procedures that are more tolerable and promote continued spinal growth in young children. Dr. Son-Hing and other orthopaedic surgeons at UH Rainbow are among the most experienced in the country at performing growing rod procedures.

Growing rods are a good treatment option for younger patients, particularly younger than age 10, with high magnitude curves or severe spinal deformity due to an underlying neuromuscular disorder. According to the Scoliosis Research Society, they are a better option for these younger patients than traditional surgical techniques that can compromise the development of the chest wall and lungs.

“Unlike treatment options such as casting and halo traction, growing rods enable pediatric patients to integrate easily into school and their social environment,” Dr. Son- Hing says.