Scoliosis: Early Detection Matters

Idiopathic scoliosis is a change in the shape of the spine when a child is growing, with “idiopathic” meaning there is no known single cause. Instead of a straight line down the middle of the back, a spine with scoliosis curves and sometimes looks more like the letter “S” or “C” rather than a straight “I.”

The most common spinal deformity in the world, idiopathic scoliosis is usually discovered in healthy school-age kids in one of two settings:

• At an annual well visit with their pediatrician, or
• At a school screening by the school nurse

The changes in our way of life due to the COVID-19 pandemic have made both these situations much less common, so scoliosis is not being detected as early.

John M. Flynn, MD, Chief of the Division of Orthopaedics at Children's Hospital of Philadelphia (CHOP) and a nationally recognized leader in the care of children with scoliosis, explains why this is a worrisome development and what we can do about it.

Scoliosis can be easy to miss

One reason scoliosis isn’t being spotted? Mild idiopathic scoliosis typically does not cause any symptoms and can easily go unnoticed by both the child and their parents or caregivers.

Unfortunately, virtual schooling eliminates interactions with school nurses, so some cases of scoliosis are not being identified.

However, there are things you can watch for at home. The most common symptoms that might be observed include:

• A difference in the height or position of shoulders, shoulder blades or hips – for example, one shoulder seems to be consistently drooping below the other
• The head not being centered with the rest of the body

If you notice any of these conditions in your child, consult your primary care physician. “It’s essential to be screened by your pediatrician for scoliosis,” says Dr. Flynn. “It is particularly important if there is any family history of scoliosis.”

Scoliosis can worsen quickly

In many kids, scoliosis worsens quickly. The pandemic may have put a stop to many activities in our lives, but it hasn’t stopped kids from growing fast!

“Scoliosis can progress very rapidly, especially as children go through their puberty growth spurt,” explains Dr. Flynn. “Several times each year, I see a patient whose scoliosis is progressing at more than 1 degree per week. If there is a delay of many months in diagnosis or follow-up, we many miss the chance to use very effective methods to prevent scoliosis progression during growth.”

The risks of delayed detection of scoliosis

When a scoliosis diagnosis is delayed, it can make treatment more challenging. At CHOP, when determining a child's best treatment plan for scoliosis, our team of specialists considers the severity of the curve, where it occurs in the spine, and the child's age and stage of growth.

If the scoliosis is mild, it may only need to be regularly monitored by a physician to make sure the curve doesn't worsen. Children can also benefit from a type of physical therapy called Schroth exercises, which work on posture, strength, breathing, the functions of daily life and self-image.

For more pronounced or severe curves, back braces are the first line of defense. If the scoliosis has progressed without detection, it may mean starting bracing with a much bigger spine curvature. That will result in bracing for a longer period of time.

If the delay in diagnosis is significant and the scoliosis exceeds 45-50 degrees, surgical correction is usually necessary. While CHOP is a world leader in spinal surgery experience and technique, we would much prefer to detect and treat your child’s scoliosis early and avoid surgical interventions.

We at CHOP are committed to safely providing care. Please don't delay a needed visit to your healthcare provider. Routine checkups are important, now more than ever!