Issue link: https://viewer.e-digitaledition.com/i/441611
F OR MANY FAMILIES the diagnosis of scoliosis for their adolescent ca n come as a sur prise. Yet unlike so many other ailments of childhood, scoliosis has a good prog- nosis with appropriate treatment, often using non-invasive measures, especially when detected early. Incidence of Scoliosis in Pediatric Populations Currently, there is no known cause for scoliosis. While genetic risk factors do seem to have some bearing, a child may not have any known relatives with the condition and still develop it. Across the adolescent pediatric popu- lation, scoliosis occurs in 2–4 percent of children between the ages of 10 to 16, according to the American Academy of Family Physicians (AAFP). Of those, only 10 percent will have curvature that becomes severe enough to necessitate medical intervention. Also unknown is the reason why girls develop scoliosis more often than boys. Comparing those with scoliosis curves more than 30 degrees, the incidence in girls versus boys is 10:1. Scoliosis progresses more frequently in girls as well, so they require treatment in greater numbers. Diagnosing Scoliosis For young patients, the annual well- child visit is critical for diagnosing any spinal curvatures. That said, scoliosis can develop quickly as a child grows — a young patient can have no detectable curvature one year and come in with a 35-degree curve the next. It's not unusual, in my experience, for patient families to be unaware of the curvature. Since scoliosis coincides with pre-pubescent development, the child may have been undergoing a number of physical changes. Moreover, adolescents can be less forthcoming and keep their bodies covered from view during this time of major physical and psychological change. Added to that is the fact that scoliosis is not associated with pain. In fact, if a patient is experiencing discomfort there may be another problem occurring not necessarily related to the scoliosis itself. In extreme cases, a patient may have difficulty breathing due to the curvature, but in these instances the diagnosis is usu- ally clear before it impacts lung function. Treatment Options For mild curvatures, those less than 25 degrees, the first approach to care is often monitoring spinal growth to determine whether the curve will get larger as the child grows. If the curvature becomes more pronounced, typically between 25–40 degrees, a body brace can help hold the spine in proper alignment during the growing years. Generally, adolescents have a choice between a brace they wear most of the day or a brace worn only at nighttime. Patient compliance figures strongly into this decision. In cases of larger spinal curvature, typi- cally between 45–50 degrees, surgery is recommended. The most standard opera- tion includes making an incision right over the back along the spine, targeting the affected area. Depending on the curvature, screws, hooks, wires or cables are used along with rods inserted into the spine to hold the area in alignment. Generally, activity is restricted for about six months to allow the spine to heal. While a scoliosis diagnosis can cause some initial apprehension for patients and their families, it's important to emphasize that early diagnosis and proper treatment can lead to an excellent result. Dr. Mark Adamczyk is a board-certified, fellowship-trained pediatric orthopedic surgeon with the Akron Children's Hospital Center for Orthopedics and Sports Medicine. He is co-director of Akron Children's Brachial Plex us Treatment Center in Akron, OH. ■ By Mark Adamczyk, MD The Key to Recovery for Adolescent Idiopathic Scoliosis Early Diagnosis: ++++++++++++++++++++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: ORTHOPEDICS 1 2 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ JA N UA RY/ F E B R UA RY 2 0 1 5