Scoliosis Revealed: Are kids too young for structural problems?
When we think about scoliosis we usually think about our kids. We remember the time when there was a “scoliosis screening” at school and they came home and told you about it. Somewhere around the 9th grade, right? After that screening we usually write it off as something you’ll never have to worry about. The truth is I have seen more lumbar scoliosis in the elderly on radiographic images than lumbar spines in a normal structural position. What kind of objective indicators were used to determine the presence or absence of the scoliosis? What if the scoliosis was present well before this? Should we leave it be and see what happens? Will it get better or worse? What are your options if it progresses? The strange thing about scoliosis is that it’s frequently paired with the word idiopathic in the medical literature. The word idiopathic means a disease or condition with no known cause. Could a traumatic birthing process initiate a shift in the delicate spine and trigger the beginning of a scoliosis? How about a slip and fall onto your head and neck? Residual structural effects from what seems to be “normal” traumas in life are common, and should be investigated.
Scoliosis is condition of spinal deformity. A disturbance in the otherwise perfectly organized 33 intercalated spinal segments causing a deviance from a normal structural position. It is divided between various classification, from age classifications to congenital or functional types of scoliosis. Children younger than 3 have been diagnosed with infantile idiopathic scoliosis. The age of someone with scoliosis is extremely important when it comes to their prognosis because catching it as early as possible can result in very positive outcomes with conservative interventions.
Congenital scoliosis is normally due to irreversible conditions like:
- Birth defects
- Spina bifida
- Cerebral palsy
- Marfan’s syndrome
- Muscular dystrophy
The good news is the prevalence of these congenital causes of scoliosis are fairly low in comparison to what is considered functional scoliosis. According to the CDC about 3 per 10,000 births are born with spina bifida and about 1 in 7,500 are born with Marfan’s syndrome. While complete reversal of the scrambled structure these individuals suffer with is unlikely, there is still hope for the management of these patients to at least have a greater quality of life.
In comparison, the prevalence of other form of scoliosis range much higher. A paper from Spine journal found that out of 75 subjects over the age of 65, 68% of them met the criteria for scoliosis. The standard criteria for scoliosis is a radiographic measurement called a Cobb angle of greater than 10 degrees. Is every child screened for scoliosis receiving objective measurement through x-ray to locate the presence or absence of this scoliosis? How effective is the screening procedure when it doesn’t involve a visual of the spine? Studies show that the procedures to evaluate for scoliosis called the Adams forward-bending is very low in effectiveness. An old wise man once said, “To see is to know.” Yet, even with these subjective screening protocols, idiopathic adolescent scoliosis seems to be a common disease with a prevalence of up to 5.2% and even higher in girls compared to boys.
Scoliosis is a terrible thing for a young child to grow up with because not only are the physical symptoms painful, but the condition comes with a poorer perception of body image and physical appearance. This can do a lot of damage on a child’s self esteem and confidence. Scoliosis is a structural shift in the spine that effects the ability of the joints, ligaments, disc, and muscles to bear the weight of the body in gravity evenly. It also affects the nervous system as it transmits signals from the brain through the spinal cord efficiently. This imbalance can create a lot of secondary conditions from aches and pains to even difficulty breathing and cardiovascular problems.
There are conservative interventions that have been shown to improve the outcomes of scoliosis seen on radiographic measurement over the course of time. Specific corrective exercise has been one approach that seems promising. Due to the loss of flexibility in the spine caused by structural deformity, it is plausible that exercises focused on maintaining flexibility, range of motion, and mirror-image movements can be useful for the treatment of scoliosis.
Another avenue that can offer hope to kids with scoliosis is structural corrective chiropractic care. Emerging research suggest that techniques specific to the structural correction and rehabilitation of the spine result in a reduction in the cobb angle measured in scoliosis in all subjects. One case study reported on a 14 month old infant with a 52-degree curve. She initially wore a risser cast from T1-L5 for 3 months and began osteopathic manipulation. At the 17th month the case was removed, and therapy was continued. After 28 months of osteopathic manipulation therapy this child’s curve had reduce to 0 degrees measured on x-ray! It’s important for kids to be checked as early as possible using objective indicators so that treatment strategies that include non-invasive low force corrections, and corrective exercise can be accessible before the scoliosis progresses and the need for surgical intervention is the only option.
[1] https://www.cdc.gov/ncbddd/spinabifida/data.html
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566258/#CR18
[4] http://www.tandfonline.com/doi/abs/10.1080/0963828032000159202
[5] http://www.sciencedirect.com/science/article/pii/S1556370711000915
[6] https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-5-32
