Paediatric Orthopaedics
Scoliosis in Children and Adolescents
Scoliosis is a sideways curvature of the spine. In most cases the cause is unknown (idiopathic), and it typically appears during the growth spurt just before puberty. Early detection allows for monitoring and timely intervention if needed.
Symptoms & Signs
What to Look For
- Uneven shoulders (one higher than the other); one shoulder blade more prominent
- Uneven waist or hips
- One side of the rib cage jutting forward
- Spine appears curved when bending forward (Adams forward-bend test)
- Clothing hangs unevenly
Most cases are painless. Back pain in a child with scoliosis should be evaluated further.
Causes
Why Scoliosis Develops
- Idiopathic (80–85%) — no known cause; runs in families and is more common in girls.
- Congenital — spinal bones form abnormally before birth.
- Neuromuscular — related to conditions such as cerebral palsy or muscular dystrophy.
- Degenerative — develops in adults from disc and joint degeneration.
Diagnosis
How Scoliosis Is Diagnosed
Curves are classified as mild (under 25°), moderate (25–40°), or severe (over 40°).
01
Physical Examination
The Adams forward-bend test checks for rib prominence.
02
X-ray
A standing spine X-ray measures the Cobb angle (the degree of curvature).
03
MRI
May be ordered if there is pain, rapid progression, or neurological symptoms.
Treatment · Step One
Non-Surgical Treatment
- Observation — mild curves in growing children are monitored with X-rays every 4 to 6 months.
- Bracing — recommended for 25–40° curves in children still growing. It does not correct the curve but aims to prevent progression; worn 16 to 23 hours a day until growth is complete.
- Physiotherapy — scoliosis-specific exercises may help in mild cases and complement bracing.
Treatment · When Needed
When Surgery Is Recommended
Surgery is typically considered for curves greater than 45 to 50 degrees, curves that progress despite bracing, or curves causing significant cosmetic or functional problems.
- Spinal fusion — the standard procedure; vertebrae are fused with rods and screws to correct and stabilise the spine.
- Growing rods — for young children who need correction but still have significant growth remaining.
Red Flags
Seek Emergency Care
- Back pain accompanies the curvature
- There is rapid progression of the curve
- Neurological symptoms such as leg weakness or numbness
- Scoliosis is detected before age 10 (early onset)
- There is a left-sided thoracic curve (more likely to have an underlying cause)
Get Started
Noticed Signs of Scoliosis?
If you notice signs of scoliosis in your child, call +966 50 580 8852 for an evaluation.
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