By Dr. Styles Bertrand, Pediatric Orthopaedic Surgeon
MCG Health System

Many schools regularly conduct scoliosis screenings for middle school students. If your child receives a referral for scoliosis based on a school screening, here are some facts you should know.

What is Scoliosis?
Scoliosis is a sideways curvature of the spine that makes the spine look more like an "S" or "C" than a straight "I". It can cause the bones of the spine to turn so that one shoulder, shoulder blade or hip appears higher than the other. Left untreated, scoliosis exceeding 50 degrees can lead to problems such as diminished lung capacity and the development of restrictive lung disease, in addition to the cosmetic concerns.

While scoliosis can run in families, the exact cause is unknown. It can occur at any age, but the most common type, called adolescent idiopathic scoliosis, occurs after the age of 10. Other types of scoliosis can occur in younger children, but are not common.

Adolescent idiopathic scoliosis does not usually cause any pain. Small curves occur with similar frequency in boys and girls, but girls are more likely to have a progressive curve that will require treatment.

Diagnosis of scoliosis requires a thorough medical history and comprehensive physical examination to determine if other problems may be causing the spine to curve. The doctor will ask your child to bend forward, which will show any deformities. He or she will also check for any limb-length discrepancies, abdominal muscle strain or other potential causes. The curve is confirmed with an X-ray of the spine. The physician will measure the degree of the curve as shown on the X-ray.

Treatment Options
The type of treatment depends on the type and size of the curve, your child's age and the number of years left to grow.

• Observation: This option is appropriate when the curve is mild (less than 25 degrees) or if your child is near skeletal maturity. However, the doctor will want to recheck the curve on a regular basis to see that it is not getting progressively worse. You may be asked to return every three to six months for re-examination. Most cases of scoliosis referred through school screening will fall into this category.
• Bracing: The goal of bracing is to prevent curves from getting worse. Bracing can be effective if your child is still growing and has a spinal curvature between 25 and 45 degrees. There are several types of braces. Most are made of thin plastic and extend from under the arms to above the hips. Your orthopaedist will recommend a brace and tell you how long it should be worn each day. Wearing a brace does not affect participation in sporting activities. The brace can be taken off for these activities.
• Surgery: If the curve is more than 45 degrees and your child is still growing, the doctor may recommend surgery. If growth is finished, surgery may still be recommended for curves that exceed 50-55 degrees. Before the operation, your child may be asked to donate blood (which will be used during the surgery as needed). The surgery requires a bone graft from the hip, ribs or a bone bank. A series of rods, hooks, screws or wires are used to straighten the spine. Following surgery, patients are walking without a brace by the second or third day, are discharged from the hospital within a week and can rapidly resume their daily activities. A return to sports is allowed after six to 12 months.

If your child’s school does not offer screenings, talk to your pediatrician about getting one. Early detection and treatment of scoliosis is important to ensure your child does not have any long-term effects.

MCG Health System is composed of three separate organizations -- MCG Health, Inc. and the clinical services offered by the faculty employees of the Medical College of Georgia and the members of the MCG Physicians Practice Group Foundation. The physicians of MCG Health System are community physicians, faculty employees of the Medical College of Georgia, or employees of the MCG Physicians Practice Group Foundation, not employees of MCG Health, Inc.  MCG Health, Inc. is a not-for-profit corporation operating the MCG Medical Center, MCG Children’s Medical Center, the MCG Sports Medicine Center, MCG Ambulatory Care Center, the Georgia Radiation Therapy Center and related clinical facilities and services. MCG Health, Inc. was formed to support the research and education mission of the Medical College of Georgia and to build the economic growth of the CSRA, the state of Georgia and the Southeast by providing an environment for faculty employees of the Medical College of Georgia and the MCG Physicians Practice Group Foundation and community physicians to deliver the highest level of primary and specialty health care.  For more information, please visit www.MCGHealth.org.