June is National Scoliosis Awareness Month

​​National Scoliosis Awareness Month takes place in June of each year to highlight the growing need for public education, early detection, and awareness about scoliosis and its prevalence within the community.

This annual campaign also unites scoliosis patients, their families, physicians and clinicians, institutions, and related businesses in collaborative partnerships of local activities, events, and grassroots networking throughout the month.

What is Scoliosis?

Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. While scoliosis can occur in people with conditions such as cerebral palsy and muscular dystrophy, the cause of most childhood scoliosis is unknown.

Most cases of scoliosis are mild, but some curves worsen as children grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly.

Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe curves.

What are the Symptoms of Scoliosis?

Signs and symptoms of scoliosis may include:

• Uneven shoulders
• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip higher than the other
• One side of the rib cage jutting forward
• A prominence on one side of the back when bending forward

In most scoliosis cases, the spine will rotate or twist in addition to curving side to side. This causes the ribs or muscles on one side of the body to stick out farther than those on the other side.

By the Numbers: Scoliosis in Children

Scoliosis is the most common spinal deformity in school-age children. (Chiro & Osteo. 2005)

• The total number of scoliosis cases in the United States is estimated to be greater than 4 million. (National Scoliosis Foundation)
• Each year, 442,900 office visits, 133,300 hospital visits, and 17,500 emergency room visits are made by children with scoliosis. (HCUP-AHRQ 2011)
• Approximately 29,000 scoliosis surgeries are performed on adolescents every year in the United States. (WJO 2015)
• The average cost of a hospital stay for a child with scoliosis is $92,000 – over five times the national average of $17,500. (HCUP-AHRQ 2011)
• Spinal deformity in children and adolescents accounts for the largest share (48%) of all musculoskeletal deformity health care visits – over 857,280 each year. (HCUP-AHRQ 2011)
• In one study, 63% of children with scoliosis reported pain - a number almost twice as high as the number reported by those who did not have scoliosis ("The pain drawing in AIS." Proceedings of the Scoliosis Research Society, 36th Annual Meeting. 2001.).

By the Numbers: Scoliosis in Adults

“Scoliosis in the adult has an impact that is similar to other common medical conditions including osteoarthritis, coronary artery disease, and chronic obstructive pulmonary disease. Overall, the burden of scoliosis on health-related quality of life is severe relative to other common medical conditions. With the aging demographic profile of the US, the burden of adult scoliosis is increasing and has a significant impact on the health of our population.” (Berven MD, et. al.)

• Adults with scoliosis are more likely to require long-term care. (BAJB 2011)
• Estimates of the direct costs of nonsurgical care in adult scoliosis (not including lost wages, time from work, cost of care providers, etc.) are estimated to be as high as $14,000 per year. (Spine 2010)
• In 2011, 229,000 adults were hospitalized with scoliosis, at an approximate cost of $15.44 million. (BAJB 2011)
• Scoliosis represents 20% of all spinal deformity cases in the United States, accounting for 1.2% of all hospital charges annually. (BAJB 2011)
• The average hospital charge for an adult with scoliosis is approximately twice as high as the national average. (HCUP-AHRQ 2011)
• 74,000 emergency room visits are made each year by adults with scoliosis. (HCUP-AHRQ 2011)
• Scoliosis patients have been shown to be 40% more likely to have suicidal thoughts (Payne et al, Spine 1997)
• Twice as many people with scoliosis report continuous pain as non-scoliosis patients, and 73% of people with scoliosis report experiencing back pain in the past year compared to only 28% of people without scoliosis. (“The Ste-Justine AIS Scoliosis Cohort Study,” Mayo et al 1994, Spine 19:1573)
• 23% of people with scoliosis reported their pain level as horrible, excruciating, or distressing, compared to just 1.4% of people without scoliosis.
• The incidence of low back pain is almost twice as high in people living with scoliosis as those without. (“The Ste-Justine AIS Scoliosis Cohort Study,” Mayo et al 1994, Spine 19:1573)

Causes and Risk Factors of Scoliosis

Doctors don't know what causes the most common type of scoliosis — although it appears to involve hereditary factors, because the disorder sometimes runs in families. Less common types of scoliosis may be caused by:

• Certain neuromuscular conditions, such as cerebral palsy or muscular dystrophy
• Birth defects affecting the development of the bones of the spine
• Previous surgery on the chest wall as a baby
• Injuries to or infections of the spine
• Spinal cord abnormalities

Risk factors for developing the most common type of scoliosis include:

• Age. Signs and symptoms typically begin in adolescence.
• Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
• Family history. Scoliosis can run in families, but most children with scoliosis don't have a family history of the disease.

Complications Associated with Scoliosis

While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:

• Breathing problems. In severe scoliosis, the rib cage may press against the lungs, making it more difficult to breathe.
• Back problems. People who had scoliosis as children may be more likely to have chronic back pain as adults, especially if their abnormal curves are large and untreated.
• Appearance. As scoliosis worsens, it can cause more noticeable changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.

Diagnosis and Treatment of Scoliosis

The doctor will initially take a detailed medical history and may ask questions about recent growth. During the physical exam, your doctor may have your child stand and then bend forward from the waist, with arms hanging loosely, to see if one side of the rib cage is more prominent than the other.

Your doctor may also perform a neurological exam to check for:

• Muscle weakness
• Numbness
• Abnormal reflexes

Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature. Repeated radiation exposure can become a concern because multiple X-rays will be taken over the years to see if the curve is worsening.

To reduce this risk, your doctor might suggest a type of imaging system that uses lower doses of radiation to create a 3D model of the spine. However, this system isn't available at all medical centers. Ultrasound is another option, although it can be less precise in determining the severity of the scoliosis curve.

Magnetic resonance imaging (MRI) might be recommended if your doctor suspects that an underlying condition — such as a spinal cord abnormality — is causing scoliosis.

Scoliosis treatments vary, depending on the severity of the curve. Children who have very mild curves usually don't need any treatment at all, although they may need regular checkups to see if the curve is worsening as they grow.

Bracing or surgery may be needed if the spinal curve is moderate or severe. Factors to be considered include:

• Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect on children whose bones are still growing. Bone maturity can be checked with hand X-rays.
• Severity of curve. Larger curves are more likely to worsen with time.
• Sex. Girls have a much higher risk of progression than boys.

Braces

If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents the curve from getting worse.

The most common type of brace is made of plastic and is contoured to conform to the body. This brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.

Most braces are worn between 13 and 16 hours a day. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.

Braces are discontinued when there are no further changes in height. On average, girls complete their growth at age 14, and boys at 16, but this varies greatly by individual.

Surgery

Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse.

Surgical options include:

• Spinal fusion. In this procedure, surgeons connect two or more of the bones in the spine (vertebrae) together so they can't move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws, or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
• Expanding rod. If the scoliosis is progressing rapidly at a young age, surgeons can attach one or two expandable rods along the spine that can adjust in length as the child grows. The rods are lengthened every 3 to 6 months either with surgery or in the clinic using a remote control.
• Vertebral body tethering. This procedure can be performed through small incisions. Screws are placed along the outside edge of the abnormal spinal curve and a strong, flexible cord is threaded through the screws. When the cord is tightened, the spine straightens. As the child grows, the spine may straighten even more.

Lifestyle and home remedies for scoliosis

There are no specific activities that are known to cause or correct scoliosis. In general, people with scoliosis have no restrictions regarding lifting or activities. General exercise or participating in sports may have the benefit of improving overall health and well-being.

Alternative medicine

Studies indicate that the following treatments for scoliosis don't help correct the curve:

• Chiropractic manipulation
• Soft braces
• Electrical stimulation of muscles
• Dietary supplements

Coping and Support

Coping with scoliosis can be difficult for a young person in an already complicated stage of life. Teens are bombarded with physical changes and emotional and social challenges. With the added diagnosis of scoliosis, adolescents may feel anger, insecurity, and fear.

A strong, supportive peer group can have a significant impact on a child's or teen's acceptance of scoliosis, bracing, or surgical treatment. Encourage your child to talk to his or her friends and ask for their support.

Consider joining a support group for parents and kids with scoliosis. Support group members can provide advice, relay real-life experiences, and help you connect with others facing similar challenges.

Preparing for a Scoliosis Appointment

Your child's doctor may check for scoliosis at a routine well-child visit. Many schools also have screening programs for scoliosis. Physical examinations prior to sports participation often detect scoliosis. If you are informed that your child might have scoliosis, see your doctor to confirm the condition.

Before the appointment, write a list that includes:

• Detailed descriptions of your child's signs and symptoms, if any are present
• Information about medical problems your child has had in the past
• Information about the medical problems that tend to run in your family
• Questions you want to ask the doctor

Your doctor may ask some of the following questions:

• When did you first notice the problem in your child?
• Is it causing your child any pain?
• Is your child experiencing any breathing difficulties?
• Has anyone in the family been treated for scoliosis?
• Has your child grown rapidly during the past six months?
• Has your child started menstruating? For how long?

Why National Scoliosis Awareness Month Matters

Awareness of scoliosis is important, as a recent study found that 72% of children and adolescents who wore back braces were able to avoid surgical intervention as opposed to 48% of children who did not wear back braces.

Early treatment of scoliosis is key.

The same study further showed that children who wore back braces for over thirteen hours each day had a success rate of over 90%. This provides strong evidence that back braces are an effective non-surgical treatment. However, for back braces to work as a treatment option, the brace must be worn for a significant amount of time. In order for this to be possible, parents have to be educated about the symptoms and screening options available.

June is the official month of Scoliosis Awareness. It’s time to speak up about your experiences so we can encourage others to screen for scoliosis. Early detection of abnormal curvature of the spine is key to preventing serious complications. By encouraging others to screen and highlighting educational resources, we can prevent and correct the advancement of scoliosis in our communities.

Sources:

https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716

https://clear-institute.org/learning-about-scoliosis/scoliosis-statistics/

https://scottishriteforchildren.org/news-items/scoliosis-awareness-month-what-is-scoliosis