Information
Editors
Scoliosis and Kyphosis
Essentials
- Severe forms of the disease that develop in the early childhood should be identified. These are caused by anomalies of the vertebrae and structural defects of the thorax. If left untreated, they may cause a significant reduction in lung volume, functional disturbance of the spinal cord and the development of a severe malposition.
- A suspicion of scoliosis in a child less than 5 years of age is always an indication to refer the child to specialized care for investigations.
- Therapy with a supportive back brace started early enough may prevent the worsening of idiopathic adolescent scoliosis in girls and surgical treatment may thus be avoided.
- Indications for surgical treatment include correction of severe malposition and securing of respiratory function, as well as alleviation of back pain and cosmetic improvement of the back shape.
Classification
- Scoliosis
- Congenital (inborn vertebral anomaly)
- Chronic maternal illnesses (type 1 diabetes, rheumatoid arthritis) and smoking during the first trimester are risk factors.
- Idiopathic
- Classified according to the age of the child at onset: infantile (0-3 years), juvenile (4-9 years) and adolescent (from 10 years of age up to the end of growth)
- Neuromuscular
- Surgical treatment of scoliosis in children with CP reduces mortality compared to those who have not been treated surgically.
- Kyphosis
- Congenital (Note! A significant risk of paraparesis if left untreated)
- Idiopathic (Scheuermann's disease)
- Neuromuscular
- In addition, different conditions (spinal cord injury, tumour, infection, developmental skeletal disorder) may lead to acquired secondary kyphosis or scoliosis.
Idiopathic adolescent scoliosis
- Most common form of scoliosis
- More common in girls than in boys (ratio 10:1)
- Develops in the phase of rapid growth (at the age of 10-12 years in girls, in boys a couple of years later).
- Differential diagnostics
- Functional, based on a difference in length between the lower extremities, rarely progressive
- Secondary scoliosis - often painful Back Pain in a Child
- Spondylolisthesis
- Juvenile intervertebral disc prolapse
- Bone tumour (osteoid osteoma)
- Screening in health checks, e.g. at school
- Inspect the child's back from behind when she/he is standing straight; note any asymmetries of the waistline or in the level of the shoulders (picture ).
- Register any difference in height between the two sides of the back in forward bend with the knees straight. This rib hump is measured with a scoliometer (picture ). A scoliometer reading > 6° (which corresponds to a radiological angle of about 10°) is significant. Also mobile apps that function as a scoliometer are available.
- If the scoliometer reading is 7° or more, scoliosis x-ray in PA projection with the patient standing is warranted. The x-ray examination should be performed in a radiological unit that is experienced in paediatric radiology.
- Treatment
- Physical training, physiotherapy and manipulation therapies are ineffective.
- Less than 25°: follow-up
- 25-45°: in a growing child (menarche not more than 1 year earlier) back brace treatment effectively prevents scoliosis from progressing to a stage that would require surgery Braces for Idiopathic Scoliosis in Adolescents
- Over 45°: surgery. The results of surgical treatment are excellent in 5-year follow-up, with the quality of life of treated patients exceeding that of untreated patients and being almost as good as that of healthy age-standardized control subjects.
Scheuermann's disease
- Scheuermann's disease is a disturbance in the growth cartilage at the anterior parts of the vertebral bodies leading to a cyphotic malposition. The disease is rarely seen in children less than 10 years of age. The malposition is initially yielding.
- The disease is more common in boys than in girls (4:1).
- Most children have no symptoms. Sometimes there is pain in the thoracic spine.
- Clinical examination reveals an accentuated thoracic kyphosis ("roundback" in forward bend), stiffness of the back movements and tightness of the hamstring muscles in the thighs.
- Diagnosis is based on x-ray imaging that shows
- wedge-shaped vertebral bodies that are flattened anteriorly (3 thoracic vertebrae)
- deformed vertebral end plates, in a later phase Schmorl's nodules (= indentations of the vertebral body endplates into the spongiosa of the vertebrae).
- Differential diagnostics: tuberculosis, fractures, tumours
- Treatment consists of
- avoidance of excessive flexion strain (e.g. weight-lifting)
- extension exercises
- back brace treatment if the kyphosis angle exceeds 60°
- rarely surgical treatment (kyphosis > 75°).
- Back brace treatment is the more effective the younger the patient and the more flexible the back.
Screening age
- The following screening ages are applied in Finland. Check local policies.
- Scoliosis, juvenile form: once during the first school-years, e.g. at the age of about 9 years
- Scoliosis, adolescent form: at the age of about 11 years (especially girls!), 12 and 13 years (boys, slowly maturing girls)
- Kyphosis: at the age of about 13-14 years
References
- Raitio A, Heiskanen S, Syvänen J, et al. Maternal Risk Factors for Congenital Vertebral Anomalies: A Population-Based Study. J Bone Joint Surg Am 2023;105(14):1087-1092 [PubMed]
- Helenius L, Diarbakerli E, Grauers A, et al. Back Pain and Quality of Life After Surgical Treatment for Adolescent Idiopathic Scoliosis at 5-Year Follow-up: Comparison with Healthy Controls and Patients with Untreated Idiopathic Scoliosis. J Bone Joint Surg Am 2019;101(16):1460-1466 [PubMed]
- Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369(16):1512-21. [PubMed]
- Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am 2005 Sep;87(9):1937-46. [PubMed]