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Scoliosis at Age 40? It's Possible - But Treatable

The Pediatric Insider

© 2011 Roy Benaroch, MD

Allison posted, “Dr. Roy, I was just (yes, at age 40!) diagnosed with scoliosis (both a curvature and rotation of my lower spine). My mother was also recently diagnosed, and my sister was previously diagnosed as a child, so I guess it runs in the family. What does that mean for my kids? What do they do nowadays for kids with scoliosis?”

There are different kinds of scoliosis, so the approach can be different.

There’s “not” scoliosis—also called “functional” scoliosis. The back looks curved, but it’s for some other reason. Maybe one leg is longer than the other, or the person is leaning sideways because of pain. Treatment (if any is needed) depends on the cause. This isn’t what most people think of as “scoliosis.”

There’s also a second kind of “not” scoliosis. (This is going to get me some flame mail, but things have been too quiet around here lately anyway!) This is the kind of scoliosis sometimes diagnosed by alternative practitioners, despite the fact that back x-rays are entirely normal and there are no genuine problems attributable to the back. A long course of frequent therapy is suggested, money is effectively extracted, and then the normal back is declared “normal”. Please be careful and watch your wallet if this kind of scoliosis is being discussed.

Moving to more serious matters, there’s rare “congenital” scoliosis, where the back doesn’t develop normally. This almost always requires aggressive therapy, preferably at a regional spine specialty center. It’s rare.

Most commonly, when we speak of scoliosis, we’re talking about “idiopathic adolescent scoliosis”, a curve and rotation (always both) of the spine that usually develops during the adolescent growth spurt. It’s more common in girls, and can run in the family. This is what school officials sometimes screen for by lining up the kids, bending them over, and staring at their backs (though the US Preventative Services Task Force actually recommends against this screening at schools because it is too inaccurate.)

Allison, if you genuinely have this kind of scoliosis, it does increase the risk of this appearing in your children, especially if you have daughters, and especially during the early years of puberty. Your children ought to be screened by a pediatrician or orthopedist at their routine yearly exams.

The treatment of idiopathic adolescent scoliosis depends on the degree of the curve, plus the potential growth that’s left. If the child is fairly young and has plenty of growth left, even a relatively small curve can become much worse—so observation will have to be closer. If the curve is approaching a level that could be harmful, bracing can help prevent the curve from worsening (though it will not correct the curve that is already there.) If scoliosis appears closer to the end of puberty, when there isn’t much growth left, typically nothing has to be done. A small amount of scoliosis will not continue to progress past puberty, and will not cause pain or any other problems.

Rarely, adolescent scoliosis can progress to a degree that can cause functional impairment of breathing and musculoskeletal function. If this has occurred, surgery will be necessary to correct the curve. It’s much better, then, to identify children well before this level of curvature has developed, so less-invasive bracing can be effective.

Physical therapy, back manipulation, and chiropractic therapy are ineffective at changing the curve of true scoliosis. However, these modalities can be helpful at relieving pain, if present. Most teenagers and adults with scoliosis do not complain of any pain.

Children ought to be screened at their yearly well-checks by a pediatrician, family doctor, or well-trained practitioner; these screens are especially important if there is a family history of scoliosis and during the adolescent growth spurt. If scoliosis is found on the physical exam, x-rays may be needed to accurately gauge the degree of curvature, and plans should be made for followup depending on the age of the child and degree of curvature. Followup might be with a primary care provider or orthopedist, depending on the risk of the curve developing into a serious problem.


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