Neuromuscular scoliosis consists of poor neurologic or muscular control of the spine and might be evident in a child born with cerebral palsy, myelodysplasia or Duchenne’s muscular dystrophy. Children diagnosed with more advanced scoliosis can often feel like they sometimes have trouble breathing and experience back/leg pain among other issues. Treatment should be individualized to maximize function and activity.
Most kids with non-severe scoliosis will not experience the painful symptoms that are often associated with scoliosis. Kids will usually be diagnosed either at a school screening being performed on the entire grade or by their doctor. Children with detectable scoliosis can appear to have a hump, “S” shaped curve in their spine, and perhaps uneven shoulders and hips while doing the Adams Forward Bending test. School examiners will inform the parent if they believe scoliosis might be present or could develop in their child. If scoliosis is discovered, it is important to see a scoliosis specialists to better evaluate the child and the doctor might take an X-ray for a better analysis. On an X-ray, the doctor uses the Cobb angle method to measure the angulations between the curving of the vertebrae.
The potential for the curvature in the spine to worsen correlates with the amount of growth remaining in the bones and spine. The amount of growth the child has left to complete is directly related to the amount and type of treatment he or she will receive since the ‘growth spurt’ years tends to make the scoliosis worse. One of the ways to measure how much growth the patient has left to complete is by taking a radiographic measure of the maturity of the pelvic bone. The Risser sign can be tracked on the pelvic X-ray to better determine if the person has more growing left to complete. The changes of puberty in girls and boys can also give insight if the person has more growing left as well. In girls, evidence suggests that the beginning of the menstrual period estimates 1.5 to 2 years of spine growth remain.
Bracing is designed to apply pressure to the trunk and pelvis, which improves the alignment of the spine and allows the spine to grow in a straighter fashion. Some doctors might recommend bracing if the scoliosis starts to pass 20 degrees measured laterally in the curve. Most doctors will recommend bracing for patients with a curvature angle around 20-50 degrees. Bracing is not designed to reverse the curvature, but rather to prevent the spine from increasing the angle of the curve. They are many different types of bracing options available with specially placed padding and straps that place resistance on the certain area in the spine. Most braces are constructed of plastic and contoured to your unique body and your doctor will help prescribe which brace is best for your treatment.
The Boston Brace is probably the most common used to treat scoliosis. These braces are made out of plastic components that are custom modeled to the patients body which creates a low-profile for the brace. On the front side, this brace extends from the lower breast to the start of the pelvic area. On the back side it extends from the upper back to the tail bone. This brace forces the lower back to flex which pushes the abdomen and helps flatten the curvature in the spine.
Although surgery can be risky and expensive, it might be an avenue to consider if severe scoliosis develops with a degree angle above 40 degrees and bracing has shown no signs of stopping the spine from continually to curve.
Children that don’t need bracing or surgery will still need to be under observation from the doctor to be aware if the spine continues to curve. The child will most likely be advised to come back for a couple follow up visits to make sure the scoliosis is not progressing into a serve curve. X-rays might be done semi-annually to make sure the curve does not worsen. Most of the time X-rays are conducted until the child stops growing or until the curving of the spine stops.
The majority of children diagnosed with scoliosis will not need any type of treatment. Less than 15% of children and adolescents diagnosed with some degree of scoliosis will actually need to begin some type of treatment including bracing and/or surgery.
There are not any specialized exercises that have been proven to help stop scoliosis. Most scoliosis in children should not prevent them from enjoying time with friends or playing sports.
Case Study
Cerebral Palsy
This 25 year old woman with severe Cerebral Palsy was confined to a stretcher and prone laying…unable to even sit in a wheelchair because of severe fixed scoliosis. 10 years previsouly, she had had an attempt at scoliosis fusion complicated by infection, failure of fusion, and eventual abandonment of scoliosis treatment. Physical exam showed an alert young woman with severe spastic quadriplegia but good head control, and she needed to be carried everywhere or set down. Her pelvis was rigidly scoliotic and fixed.
At ScoliosisTexas we prepared her for surgery with a nutritional plan and medical clearances. We performed a posterior alone complex spinal reconstruction with posterior column osteotomies, Gardner-Wells-femoral traction, intra wound antibiotics, allograft, and BMP. Her result immediately was dramatic, being able to sit in a wheelchair for the first time in 9 years. At two years she is alert in a wheelchair with perfect alignment. Both her sitting and improved ability for home nursing care were the results of this complex surgery.
