Scoliosis is a term used to describe abnormal lateral curvatures of the spinal column. Although usually only 10 percent of diagnosed curves actually require therapeutic intervention the consequences of untreated curves that do progress can be quiet serious. Due to the potentially serious consequences, it is paramount that pre-adolescent children be screened for potential signs of developing scoliosis.  This screening should continue throughout the adolescent period.

There are different categories of the condition but this article will be discussing Adolescent Idiopathic Scoliosis. Adolescent idiopathic scoliosis may be present in 2 to 4 percent of children between the ages of 10 to 16. It is defined as a lateral curve that is greater than 10 degrees and is accompanied by rotation of the vertebra. The greatest concern regarding scoliosis is that the curve may progress to a severe degree which can cause compromise of lung and heart function. Outside of serious lung and heart complications scoliosis may also lead to serious deformity and postural alterations. Altered biomechanics of the spine may cause premature arthritic changes later in life.

The term “idiopathic” is a very important consideration when classifying the type of scoliosis being identified. This term indicates that there is no known cause for the scoliosis. The other broad classification of scoliosis is termed “secondary”. Secondary indicates that there is an underlying pathological condition that is responsible for the spinal curvature. Examples of secondary causes include a long list of inherited genetic disorders, neurological conditions, spinal tumors as well as various musculoskeletal conditions. Due to the potentially serious nature of these secondary causes, the first step once a curve has been identified is to rule out a secondary cause. Severe pain, a left thoracic curve or an abnormal neurological exam are red flags that may indicate a secondary cause for the curvature.

The greatest time of risk for curve progression is during periods of growth. This is why it is very important to screen for spinal curvatures before the period of significant growth. Various guidelines exist with varying scientific evidence to support them but a good general guideline is to begin screening around age 10 and continue at a regular interval (once or twice a year) until age 15 or 16. Some may question this frequency but in practical terms screening takes less than 5 minutes and requires no invasive or highly technical equipment. It generally includes a postural analysis, inspection of the spinal column while standing and a simple orthopedic test referred to as the Adam’s forward bending test.  With this test the patient is instructed to simply bend forward as if touching their toes, the spine and back are then observed for asymmetrical rib heights which are associated with spinal scoliosis.

If an abnormal spinal curvature is detected during the screening procedure the next step is to determine the degree of risk of progression. Several factors need to be weighed to determine if a referral to an orthopedic specialist is required or if it may be appropriate for the family physician or family chiropractor to simply monitor the curve and watch for signs of progression that may then require the appropriate referral.

Treatment for scoliosis remains controversial. Treatments such as physiotherapy, chiropractic, biofeedback and electrical stimulation have shown limited effect on the natural history of scoliosis but can be effective in keeping the spine more flexible, increasing function and relieving potential discomfort that may be associated with the condition. More invasive procedures such as bracing and spinal surgery have shown effectiveness at altering the progression of spinal curves. These more invasive procedures must be weighed carefully between potential risks and benefits.

Look for signs of abnormal spinal curvature. If you think you see something unusual seek the advice of a health expert like a chiropractor, physiotherapist or family doctor.