Juvenile Scoliosis: Causes, Diagnosis and Treatment Options

While there are never treatment guarantees, juvenile scoliosis is a condition type I'd like to draw attention to. With early detection, there are fewer limits to what can be achieved because this age group has yet to have their first adolescent growth spurt; growth triggers progression.

Scoliosis can affect all ages but is most commonly diagnosed in children, and juvenile scoliosis is diagnosed between the ages of 3 and 10 years old. Early onset scoliosis curves, when diagnosed and treated early, are more likely to respond positively to treatment.

Let's start our exploration of juvenile idiopathic scoliosis by first discussing how the condition is diagnosed.

Diagnosing Scoliosis Curves

There are many different types of unnatural spinal curves, so to be recognized as a scoliotic curve, certain parameters have to be met.

Scoliosis curves bend sideways unnaturally and rotate, and it's the twisting from back to front and front to back that makes scoliosis a complex 3-dimensional condition.

So a scoliotic curve doesn't just bend unnaturally, it also twists, and in addition, the size of the unnatural spinal curvature has to have a minimum Cobb angle of 10 degrees.

When scoliosis is diagnosed, the process involves comprehensive assessment to further classify conditions based on key patient/condition variables: patient age, condition severity, curvature location, and condition type.

Classifying scoliosis not only streamlines the treatment process, but also informs the customization of potentially-effective treatment plans.

Before getting to the specifics of juvenile idiopathic scoliosis, let's first explore what these classification-points indicate and why they're important.

Patient Age

Patient age is important not only because it indicates overall health, but also because this is a factor that greatly shapes the condition's progressive rate, as well as how painful it's likely to be.

While we don't always know what causes the initial onset of scoliosis, we do know what causes it to progress: growth and development.

So the more growth a young patient has yet to go through, the more at risk they are for continued progression, which is why proactive treatment is so important.

In adults, for whom the progressive trigger of growth has been removed, progression tends to be slower, but still occurs, particularly in older adults facing natural age-related spinal degeneration.

Pain is also shaped by patient age because scoliosis doesn't become a compressive condition until skeletal maturity has been reached, and it's compression (uneven forces) of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.

Young patients don't experience compressive pain because the constant lengthening motion of a growing spine counteracts the compressive force of the curve, which is why so many cases of childhood scoliosis go undiagnosed and untreated until skeletal maturity has been reached, causing the condition to become painful and noticeable; it's pain that brings most adults in to see me for a diagnosis and treatment, and this can include back pain and pain that radiates into the extremities due to nerve compression.

While young patients can certainly experience varying degrees of muscle pain, when it comes to back pain and nerve pain, this is more common in adults than children.

Condition Severity

As mentioned earlier, a scoliotic curve has to have a minimum Cobb angle measurement of at least 10 degrees, and this is determined during X-ray by drawing lines from the tops and bottoms of the curve's most-tilted vertebrae, and the resulting angle is expressed in degrees.

The higher the Cobb angle, the more out of alignment the spine is, the more severe the condition, and the more likely it is that its effects are going to be noticeable:

• Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40+ degrees
• Very-severe scoliosis: Cobb angle measurement of 80+ degrees

Condition severity is a key factor that treatment plans are customized around, and in most cases, the more severe the condition, the more likely it is to continue progressing, and the more in need of treatment the patient is.

Regardless of condition severity, the best time to start scoliosis treatment is always now; as a progressive condition, it only gets more complex to treat over time.

Curvature Location

The spine has three main sections, and scoliosis can develop in any one section, or in more than one as a combined scoliosis: the cervical spine (neck), thoracic spine (middle/upper back), and the lumbar spine (lower back).

Curvature location doesn't just tell me where to concentrate my chiropractic adjustments, it also indicates the type of condition effects that can be expected; in general, the area of the body located the closes to the affected spinal section is going to feel the majority of the condition's direct effects.

For example, a common complication of lumbar scoliosis is sciatic nerve pain; the sciatic nerve starts in the lumbar spine and extends down the back of the hip, buttocks, leg, and into the foot.

If the lumbar spine is bent and rotates unnaturally, it can expose the nerves within to uneven pressure, and they can become pinched, impinged, and irritated as a result.

While sciatic nerve pain is more common in adults, it does show how curvature location can shape the types of symptoms a patient is going to experience.

Unnatural spinal curves in the thoracic section will largely affect the middle and upper body; thoracic insufficiency syndrome can develop due to a chest wall deformity that can be caused by severe early onset scoliosis and/or congenital scoliosis.

If the cervical spine loses its healthy curvature, it can disrupt the neck's ability to support the weight of the head, cause headaches, shoulder and neck pain, and can disrupt the neck's range of motion, as well as communication between the brain and the rest of the body.

Condition Type

Not only does scoliosis range widely in severity, there are also different types of scoliosis that can develop, and type is determined by causation.

The most common type of scoliosis to affect all ages is idiopathic scoliosis: not clearly associated with a single-known cause.

Idiopathic scoliosis accounts for approximately 80 percent of known diagnosed cases, and the remaining 20 percent are associated with known causes: neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.

Cases with known causes are considered atypical because they have an underlying pathology causing their development: neuromuscular scoliosis is caused by the presence of larger neuromuscular diseases like spina bifida, muscular dystrophy, and cerebral palsy.

Degenerative scoliosis is caused by natural age-related spinal degeneration and the cumulative effect of certain lifestyle factors.

Congenital scoliosis is a rare form affecting approximately 1 in 10,000, and it's caused by a malformed spine that develops in utero; babies are born with the condition and often present with additional congenital abnormalities that can disrupt normal lung development and cardiac function.

Treatment for atypical scoliosis can be challenging, and when treating babies, there are a number of challenges; in some cases, assessment, observation, and scoliosis casting can be helpful.

Now, under the umbrella of idiopathic scoliosis, the condition can be classified further so let's talk about the different types of idiopathic scoliosis.

Infantile Idiopathic Scoliosis

As mentioned, congenital scoliosis affects newborn babies as they are born with it, and infantile idiopathic scoliosis is diagnosed in infants between the ages of 6 months and 3 years old.

While some cases of infantile idiopathic scoliosis resolve on their own, there is no way of knowing which will resolve, and which will progress with growth and maturity as a child grows.

Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis is the most prevalent type of scoliosis overall, and this type is diagnosed in children between the ages of 10 and 18; this age group is the most at risk for rapid-phase progression due to the rapid and unpredictable growth spurts of puberty.

Because the constant trigger of growth is there, a large focus of treating adolescent idiopathic scoliosis is on achieving a curvature reduction and holding it there throughout growth.

Juvenile Idiopathic Scoliosis

Now, in between infantile scoliosis and adolescent scoliosis, juvenile idiopathic scoliosis would fall as this type is diagnosed between the ages of 3 and 10 years old.

Early onset juvenile scoliosis patients haven't yet had their first adolescent growth spurt, known to cause the condition to progress significantly, and with early detection, this condition type can be highly responsive to treatment.

The cause of idiopathic juvenile scoliosis is unknown and diagnosing it involves a combined physical examination and X-ray results.

A physical examination commonly involves taking juvenile patients medical and family history, an Adam's forward bend test, observing patients' posture and gait, and X-ray results.

When I have a child bend forward at the hips, the spine is in a highly-visible position, as are any postural asymmetries caused by the condition's uneven forces, and when combined with the use of a Scoliometer, I can also determine a patient's angle of trunk rotation (ATR).

If an Adam's forward bend test shows indicators of scoliosis, further testing in the form of a scoliosis X-ray is warranted; I can truly see what's happening in and around the spine and confirm a patient's Cobb angle measurement to officially reach a diagnosis of scoliosis.

So once a diagnosis of juvenile scoliosis is reached, what are the types of symptoms a young patient can experience?

Juvenile Scoliosis Symptoms

When it comes to scoliosis symptoms, it's important to understand that regardless of type or severity, all forms of scoliosis are progressive, so symptoms a patient is experiencing at the time of diagnosis isn't indicative of future symptoms; as a progressive condition, scoliosis has it in its nature to get worse over time.

Symptoms tend to become more noticeable as scoliosis progresses, and in children, the main condition effect is postural deviation due to how to the condition's uneven forces disrupt the body's overall symmetry.

Untreated early onset scoliosis in juveniles that's diagnosed as mild scoliosis can easily progress to become moderate scoliosis, severe and very severe scoliosis; the best way to prevent progression is through proactive treatment.

So what are the earliest signs of scoliosis in juveniles?

Postural changes to be expected in children with scoliosis can include:

• The head appearing uncentered over the torso
• An uneven eye-line
• Uneven shoulders
• Uneven shoulder blades (one shoulder blade protruding more on one side)
• The development of a rib cage hump
• Uneven hips
• An uneven waistline
• Arms and legs that appear to hang at different lengths

As a result of the postural changes, clothing can suddenly seem ill-fitting with necklines favoring one side and clothes hanging off the body unevenly.

Additional symptoms can include changes to balance, coordination, and gait; as scoliosis progresses, the spine is becoming increasingly curved, and this can shift the body's center of gravity, causing additional effects.

As an unnatural spinal curvature progresses, its effects tend to become more overt, and in children, this means that postural changes will become more noticeable; the majority of my patients have moderate scoliosis, and this is because it's often not until scoliosis progresses from mild to moderate that its postural changes start to become noticeable.

Particularly in mild cases, scoliosis isn't associated with functional deficits, and as it's not yet compressive, scoliosis isn't generally painful for children, and if its postural changes are subtle, early detection can be a challenge.

Juvenile Scoliosis Treatment Options

When it comes to treating juvenile scoliosis, time is of the essence because if a large impact can be made prior to the first adolescent growth spurt, progression is more manageable; although scoliosis is progressive and incurable, it can be highly treatable.

A child's age at the time of diagnosis is important because it tells me how much I am going to have to focus on counteracting the condition's progressive nature: the goal is to reduce the unnatural curvature of the spine and hold the reduction, despite the constant trigger of growth.

An abnormal curvature of the spine can be responded to with two different types of treatment: traditional and conservative.

Traditional scoliosis treatment tends to funnel patients towards spinal fusion surgery which carries some serious potential risks, side effects and complications, and in addition, it can negatively effect the spine's long-term health and function, and particularly when talking about young patients, I feel preserving the spine's natural strength and function is key.

If juvenile scoliosis has been diagnosed, this means the patient hasn't yet started puberty and its rapid and unpredictable growth spurts, and a spinal curve that's mild and hasn't yet progressed significantly is more likely to respond to treatment.

The reality is that many cases of scoliosis don't require surgery, and conservative treatment offers a non-surgical treatment alternative that is chiropractic-centered and effective, particularly with early detection and intervention.

Conservative treatment is integrative so combines multiple scoliosis-specific treatment disciplines so conditions can be impacted on every level.

Chiropractic Care

Chiropractic care works towards impacting the condition on a structural level through a series of techniques and manual adjustments that have the goal of adjusting the position of the curve's most-tilted vertebrae back into alignment with the rest of the spine.

Restoring the spine's alignment means restoring as much of the spine's healthy curves as possible and this improves spinal biomechanics, health, strength, and function.

As a structural condition, scoliosis involves an abnormality within the spine itself so has to be impacted primarily on a structural level, in the form of a curvature reduction.

Physical Therapy

It's not just the spine that has to maintain its natural curves and alignment, but also its surrounding muscles that provide the spine with crucial support and stabilization.

Physical therapy can help increase core strength so the spine's surrounding muscles can optimally support it, and it can also improve posture and activate certain areas of the brain for enhanced brain-body communication.

Physical therapy and scoliosis-specific exercises and stretches can also help address any related muscle imbalance caused by scoliosis; as an unnatural spinal curve pulls the spine in different directions, it can cause the muscles on one side to become stretched and loose from overuse, while muscles on the other side become weak from underuse.

As an asymmetrical condition, a muscle imbalance is a common effect, and it doesn't help counteract an unnatural spinal curve with abnormal rotation.

Corrective Bracing

Corrective bracing is particularly effective on growing spines so is a common facet of treatment for scoliosis that affects children.

Here at the Scoliosis Reduction Center, I favor modern corrective bracing because it represents the culmination of what we've learned about scoliosis and treatment efficacy over the years.

An ultra-corrective scoliosis brace like the ScoliBrace can help achieve corrective treatment results by pushing the spine into a corrective position.

The ScoliBrace addresses many of the shortcomings associated with traditional scoliosis bracing:

• Corrective bracing pushes the spine rather than squeezing and weakening it
• Corrective bracing addresses the condition as 3-dimensional, while traditional bracing ignores its rotational component
• The ScoliBrace has better compliance rates because it's more comfortable and less bulky to wear
• The ScoliBrace is custom-designed to suit the specifics of each patient's condition/body type

When used in conjunction with other forms of treatment with corrective potential, brace treatment can be a valuable treatment tool for addressing juvenile scoliosis.

Rehabilitation

If the initial treatment is completed and a curvature reduction has been achieved, efforts still have to be made to sustain those results for the long term; remember, the nature of scoliosis is still going to be to get worse over time.

Rehabilitation can involve continued chiropractic care and a series of custom-prescribed home exercises to further heal and stabilize the spine from home.

Scoliosis-specific exercises have corrective potential and can help by keeping the spine loose, flexible, and strong, and they can also help maintain healthy posture and address spinal muscular atrophy.

Conclusion

While there is no way to cure scoliosis, it can be highly treatable and manageable, and while there was a time when mandatory scoliosis screening was conducted in schools across the United States, that has since changed, shifting the onus of early detection onto the shoulders of parents and patients themselves.

The best thing a parent can do is be educated on the early signs of scoliosis in juveniles so early detection and intervention is possible; this makes treatment success more likely.

When a child's spine has an unnatural bend and twist, it should be taken seriously, particularly as a progressive condition triggered by growth.

The Scoliosis Research Society has current estimates at close to seven million people living with scoliosis in the United States alone, and as the leading spinal condition amongst school-aged children, it warrants awareness.

While there are never treatment guarantees, childhood scoliosis that's diagnosed and treated early in the condition's progressive line is more likely to respond.

Scoliosis progressing means the size of the unnatural spinal curve is increasing, as are the condition's uneven forces, and their effects; mild curves are simpler to treat than severe curves.

As scoliosis progresses, the spine becomes increasingly rigid, making it less responsive to treatment, and once a significant amount of progression has occurred, spinal rigidity can make it difficult for some patients to perform key therapeutic exercises as part of treatment.

Active treatment is needed to work towards preventing progression and increasing condition effects; it's far more effective to prevent progression than it is to attempt to reverse its effects once they're established.

Pediatric patients should always try a safe non-invasive treatment approach before considering the risks of spine surgery.

So juvenile scoliosis is diagnosed between the ages of 3 and 10, and when diagnosed early, this is the age group I can make the biggest impact with because they have not yet had their first significant pubescent growth spurt that triggers progression.

Here at the Center, I provide modern conservative scoliosis treatment to patients of all ages as I feel this is the best approach for preserving natural spinal strength and function: something that shapes a young patient's overall quality of life.