Hey, bud, can you scratch my back?” Those were the seven words that changed Jordan’s life, who was then in the ninth grade. “Something is funny about your back,” said, Kevin, a classmate of Jordan’s. Kevin innocently felt a curve on his back which seemed strange. It’s unusual to find out from another classmate that you possess Idiopathic scoliosis.

Adolescents may find out some way that they have Idiopathic scoliosis. It might be at a formal event or while they are attending a recreational activity where their back is exposed. Some are unsure of whom they should approach or simply just ignore it and will never get it checked out. Today we will discuss of how a ninth grader, Jordan was diagnosed with Idiopathic scoliosis.

Jordan’s doctor’s assessment included the following options

• Degree and extent of the curvature It’s severity and direct effect on Jordan

• Spinal skeletal maturity Is Jordan’s spine still growing?

• Where is the skeletal curve located? Is it lordotic curve or is it a kyphotic curve?

• Possibility of the curve progressing If Jordan’s curve was present prior to adolescence.

About three percent of the population today will develop scoliosis. According to The National Scoliosis Foundation, every year, about 600,000 scoliosis patients visit a doctor’s office to confirm some type of curvature of the spine. How would someone know that they are suffering from scoliosis if they do not ask assistance for a back itch like Jordan?

Three types of scoliosis curves

There are three main types of scoliosis, congenital (from birth), idiopathic (adolescent), and adult scoliosis. Adolescent idiopathic scoliosis appears during the adolescent growth spurt when the person is going through puberty, a time when children are growing rapidly (idiopathic is defined as having no identifiable cause). In many cases, the abnormal spinal curve is stable, although in some children the curve is progressive (meaning it becomes more severe over time). For unknown reasons, severe and progressive curves occur more frequently in girls than in boys. However, mild spinal curvature is equally common in girls and boys.

This article will concentrate on Idiopathic scoliosis which abounds when the patient is between ten and eighteen years of age. It is also called adolescent Idiopathic scoliosis (AIS). There are no proven causes for this condition, although research is looking for specific genes that could cause this condition, since there is a thirty- percent chance of recurrence in families that have it. This is because of a common genetic makeup that will create similar outcomes in two biologically related individuals. Generally, patients are healthy and have no previous medical history. Some experts claim that the cause can come from some type of muscle or hormonal imbalance.

There are no specific nerve or pain problems with AIS. The curvature does not put pressure on the organs such as the lungs as do the congenital and adult scoliosis issues. Yes, teenagers complain of back pain, however, this usually can be attributed to the large number of activities they are involved in ranging from sports to dancing depending on gender. Most teens suffering from back pain do not have good core abdominal and back strength, or flexibility of the hamstrings, except for those children involved in gymnastics. Those who are more flexible will also have the benefit of being spared of scoliosis.

My child has scoliosis now what?

One should not get nervous right away about treatment for AIS. The spine (sometimes called backbone), is made up of many vertebrae that are connected by cartilage (elastic tissue). This bone makeup will give a normal person the flexibility he needs for stretching, bending, balancing, and walking. If a person is suspected of having scoliosis, his spine will have a curve the shape of an S instead of being straight. Small curves do not usually cause problems. Experts use a scale of percentages to determine if the curvature is severe enough to warrant medical intervention. In many children with mild scoliosis, the spinal curve is mild enough not to require any treatment. If the doctor is concerned about the curve increasing, he or she may ask to examine the child every few months throughout their adolescence or until they stop growing.

What’s the difference between adolescent scoliosis & early onset scoliosis?

We must distinguish between adolescent scoliosis and early onset scoliosis. If scoliosis is present under the age of ten it is referred to as EOS (early onset scoliosis). This is because children under ten years of age are still growing at a greater pace than the ones after ten years of age. Early onset scoliosis can cause more problems than just a curvature to the spine. Lung development, malformed ribs and heart disease are dangerous complications that can develop with EOS. Children with EOS may not show any symptoms outwardly, especially if the curve is mild. A medical expert must look at the symmetry and contour of the waist, see if the head is tilted and check for uneven hips.

Pediatricians will sometimes use a screening test for grade school children called, Adam’s Forward Bend Test. The patient leans forward with his or her feet together at a 90-degree bend from the waist. The examiner will be able to detect any asymmetry of the trunk or any abnormal spinal curve. This is a simple non-invasive screening test that can detect potential problems without accurately determining the acuteness of the deformity. The same lab tests will be used for EOS and AIS, including but not necessary all, X-rays, CAT scans, and MRI’s.

Predominantly, by the time a child reaches the age of ten, spinal growth slows down. If at this point in their life there is a significant curvature, it can continue into adulthood. Some of the symptoms to look for, are uneven shoulders, leaning torso and in some cases rib protrusion, uneven leg measurements, the head not in line with the pelvis, and the rib cages at different heights on each side. The earlier the treatment is started the more likely it will be one hundred percent successful. The early stage of intervention is when the curve is 30 degrees or less. Here the success rate will be one hundred percent! The Cobb Method is used to diagnose the severity of the curve. Any curve of 10% and above requires medical intervention, from minor physical therapy, to brace therapy and only in very severe cases, surgery.

Curves between 30% and 49% will have a success rate of up to 92%. Curves of 50% or higher have a danger of a 50% success rate. Braces, especially the new types together with physical therapy will jump the success rate substantially. There are other new treatment options other than surgery that have come on the market recently. One of them is the WCR Brace, made by Dr. Jacques Cheneau of France and Dr. Emanuel Rigo of Barcelona, Spain. Each brace is custom designed according to each patient’s pressure and breathing points. One can correct the scoliosis by wearing the virtually unnoticeable brace.  

There is a new option for teens with curvature of 25 % and above. It’s called, Scoliosis Boot Camp with rigorous habit changing routines. Identical twins, Matty and Violet were both diagnosed with AIS. Matty’s curvature rate was 37% and her sister Violet’s was 47%. Maddie’s diagnosis was bracing, and Violet’s was spinal fusion surgery. Their mother researched other options until she found a two-week scoliosis boot camp. They are so happy with the results after two weeks. Maddie’s curve decreased to 18% and Violet’s lessened to 15%.

The twins were required to buy sophisticated equipment to use at home with at least one-half hour of self-therapy every day for approximately two years. They are thrilled with the results and are starting high school surgery and brace free. A child, using this program, must be quite disciplined for such a self-therapy program to work. A visit and evaluation at an outpatient scoliosis therapy center can help you decide what kind of therapy is right for your child. Check if your child’s school has a scoliosis screening program. Screening for AIS is by no means routine. About half of the states currently prescribe school screening. The four leading scoliosis organizations are, Scoliosis Research Society, American Society of Orthopedic Surgeons, Pediatric Society of North America and American Pediatrics who provide support for school screening programs. Early identification will allow for easier non-surgical management and prevent further progression of any spine curvature. Please respect your child’s privacy and make sure the screening is done in a modest manner.

If your child is diagnosed with scoliosis, don’t panic. A curve is considered mild if it is less than 20 degrees. Between 25 and 40 degrees is still considered mild. A severe curve would be 50 or more degrees. There are so many wonderful options, other than surgery today. Be thankful that it happened in this millennium where new and improved options become available each year. Always be sure when researching online, that you check the year of the website’s information. There is so much new information coming out each day.

“A trip to Disneyworld, how did that happen?” asked Julie’s excited daughter, Kate. Her older sister, Stephanie, was not as thrilled as her sister. Truth be told, Stephanie has been to Disneyworld before, but so has her sister, Kate. The newest attraction this year, Star Wars Galaxy’s Edge, is the attraction that both Stephanie and Kate were eager to experience, along with the other attractions that they loved. So why is Kate much more primed than Stephanie?

The way it happened was that Julie’s husband, Gary, finally collected enough points from their credit card purchases to land a great deal on airfare from New York and hotel accommodations, to Orlando. It was so fortunate for them that they were able to pull this family trip off. Julie, Gary and family had to make the best of the situation with each of their daughter’s scoliosis circumstances (thirty percent of scoliosis patients have a family history of scoliosis).

Both Stephanie and Kate are being treated for scoliosis. Stephanie, as the older sister, did not have the advantage that Kate had, with the new European Schroth therapy and lightweight Rigo-Chêneau Brace system. Unfortunately, at the time of Stephanie’s, scoliosis surgery, her devoted parents, were not privy to the modern European originated Rigo-Chêneau Brace and the Schroth individual therapy regiment. These two new innovations from Europe, have revolutionized and simplified most treatments to correct scoliosis in children and teenagers.

Let’s compare the two ways of treating scoliosis with Stephanie and Kate as illustrations. Stephanie’s parents were given only one option by several doctors, and that was scoliosis surgery. The surgeon, during the surgery, makes several small incisions along the child’s back. A device called a retractor is then inserted internally. The surgeon is then able to reach the spine with small tools. After that is done, some screws and rods, customized for each patient, are attached to the spine to make it straighter.

In most cases scoliosis surgery is cosmetic. Only in a few cases, when a child is younger than five years old and the lungs are not fully developed could scoliosis affect the child’s breathing. Yes, the child will have an immediate cosmetic improvement after surgery (my great niece became several inches taller post-surgery). However, there is a noticeable scar going down Stephanie’s entire back which would be called a cosmetic flaw at the pool.

An article in the American Journal of Orthopedics, published in 2015, discusses a study of 118 patients, ages 10-17 who underwent scoliosis correction surgery, a minimum of five years before. They complained of common symptoms, including occasional back pain (76%), limited range of motion (44%), activity limitations (46%), waistline imbalance (35%), rib prominence (24%), wound/scar problems (15%), and shortness of breath (15%). Physical therapy is often required after typical scoliosis surgery. Long lasting pain from both the bone graft site and shoulder pain is common after this surgery.

What is the alternative to scoliosis surgery?

Today, non-invasive methods will not only curtail the spine curvature but will reverse it. Unlike the traditional, old-fashioned scoliosis surgery, the Rigo-Chêneau Brace and Schroth therapy, have both short term and even more importantly, long term advantages over surgery. Statistics have shown that up to two out of every thousand surgeries are fatal. Almost 20% of the patients will require additional surgery within two to eight years to alleviate pain. Most of the time, there is absolutely no medical reason for surgery.

So, have you figured out why Stephanie is hesitant about going to Disneyworld?

Traveling by plane today is quite challenging for most of us. From making it on time to the airport, to making sure the luggage is the right size, most of the initial excitement of traveling is minimized this day and age. How about the issues of getting through security? While Stephanie’s siblings are already safely on the way to the gate, Stephanie is being scanned up and down her back for the permanent hardware she carries from her surgery.

Kate is also being treated for her scoliosis. She must wear a brace and do her daily exercises. However, unlike her sister, she is not in pain. She is neither subjected to countless back pinging’s by TSA security personnel. Kate will be able to wear her lightweight neatly decorated brace on the plane and she did not have to remove it before being scanned at the airport. There is no major hardware attached to it, so in most cases she will not be stopped by a beep of the security machinery. Later, in the privacy of her hotel room, she will do her required physical therapy exercises for her scoliosis.

Stephanie still must do her exercises, but her shoulder pain makes it quite unpleasant for her. Kate’s brace is lightweight and easy to clean. The brace is usually worn for about twenty-three out of twenty-four hours a day, until the person reaches bony maturity. The length of brace wearing, varies from person to person depending at what age the person stops growing. Patients are encouraged to remain active and continue activities that are important to them. Sometimes, a full twenty-three-hour regiment may not be possible.

For example, Stephanie and Kate began their vacation with a hop and jump into the pool. The brace should be removed before activities that necessitate full movements of the spine. It is not worn in the pool or shower. However, Kate will be able to wear her brace on most of the Disneyworld park rides.

Let’s join the sisters at the pool. Kate removed her Rigo-Chêneau Brace, before putting on her new bathing suit. Stephanie also has a new swimsuit. Hers, however, was specifically chosen with a high back to cover her long scoliosis surgery scar. Their mom, watched painstakingly, as the two sisters played in the pool. She noticed how much more agile Kate was than Stephanie. Before, Stephanie’s surgery, Stephanie was quite the super-diver-swimmer. Now, however, she was swimming somewhat less gracefully than Kate. When they went up to the diving board, Stephanie stood a little too straight to make a real deep dive. When she came out of the pool, her mom complimented Stephanie on her diving, but asked why she did not bend more to get a deeper dive? Stephanie admitted that her back hurts when she bends it too much.

With the girls back in the pool, several minutes later, Julie, their mom, had a chance to call the therapist at Kate’s scoliosis therapy center. First, Julie described to her how nicely Kate was doing on vacation. She wasn’t wearing the brace the full twenty-three hours, as prescribed, but she was doing her exercises quite diligently. The understanding therapist assured Julie, that if Kate was wearing her brace to sleep, and most of the waking hours of the day, things would be fine.

It was now or never. Julie mustered up her courage and asked the therapist straight out if there was anything the scoliosis center could do for her older daughter, Stephanie. The therapist explained to Julie, that new curves can crop up years after the back surgery was performed. She answered decisively, that yes, Julie, should bring Stephanie in for a scoliosis evaluation as soon as the family returned from Florida.

Progression of new curves can be reduced and eliminated by follow up appointments and continued physical therapy. If necessary, bracing treatment could be required. Julie, Stephanie’s mom, was both relieved and alarmed. She thought that treatment times with Stephanie had passed, now it seems she might need to repeat them. No, Julie, told herself, not repeat them, try new ones. Looking at the situation in a positive light, relaxed her and Julie made up her mind to start enjoying the short vacation.

Stephanie was hesitant about going on some of the more exciting rides in Disneyworld, since she did not want her back to hurt or even more frightening needing to undergo additional surgery for any minor injury caused by sudden unpredictable movements. Stephanie looked at her sister and wished she could have had the brace instead of the surgery a few years ago. Looking back, she remembered, how the doctors promised her that she will be taller and straighter with the surgery. Yes, it is true, she did become taller and straighter but the price she and her parents paid in pain and aggravation was dearer, when compared to her sister, Kate’s experience, which is so much easier and more comfortable.

We must understand that Kate’s body never had to go through the trauma of scoliosis surgery, nor will she be subjected to any surgery in the future. She is living in the same body that she was born with. She is getting long term benefits from both the custom brace that she wears for most of the day and the wonderful physical therapy that she receives. Kate’s physical and brace therapy will stop the curve from advancing, and possibly reversing it. It will also reduce both the spinal deformity and rib visibility.

Stephanie’s story is but one example of the disadvantage of scoliosis surgery. Before contemplating any back surgery for your child, make sure to explore all alternative therapies.

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