Childhood Scoliosis: Common Causes and Conditions

Scoliosis can affect all ages but is most commonly diagnosed in children. As a progressive condition triggered by growth, childhood scoliosis should always be taken seriously and treated proactively. Condition type is determined by causation, and different types can be associated with different symptoms and treatment needs.

Most cases of childhood scoliosis involve idiopathic scoliosis: no known cause. Atypical types of childhood scoliosis with known causes include neuromuscular scoliosis caused by the presence of a larger neuromuscular condition, and congenital scoliosis caused by a malformed spine.

As most cases of childhood scoliosis are idiopathic scoliosis, let's start there.

What's Idiopathic Scoliosis?

Idiopathic is a medical term meaning cause unknown, and when it comes to scoliosis, approximately 80 percent of known diagnosed cases are classified as idiopathic.

Idiopathic scoliosis has no single-known cause, and is instead considered to be multifactorial: caused by a number of factors, or a combination of factors, that can vary from one patient to the next.

The most common type of scoliosis to affect children and adults is idiopathic scoliosis, and the most common type of scoliosis overall is adolescent scoliosis.

Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis is diagnosed between the ages of 10 and reaching skeletal maturity; once growth has stopped, it becomes adult scoliosis.

Although we don't know why most cases of childhood scoliosis develop initially, we know what makes it progress, and that's growth, and as a progressive condition triggered by growth, a child's growth spurts can cause the size and rotation of the unnatural spinal curve to get larger and more severe.

Adolescents with scoliosis are the most at risk for rapid phase progression because of the rapid and unpredictable growth spurts of puberty.

And as a condition that ranges so widely in severity from mild scoliosis to moderate scoliosis, severe and very severe scoliosis, if not diagnosed and treated early, scoliosis surgery can be recommended.

Infantile Scoliosis

Idiopathic scoliosis can affect infants as young as 6 months: infantile idiopathic scoliosis.

Infantile idiopathic scoliosis is diagnosed in children between the ages of 6 months and 3 years old, and while some cases of infantile scoliosis resolve on their own and don't progress with growth, there is no way of knowing which will, and which won't.

It's always safer to be proactive and apply treatment early on; the milder scoliosis is at the time treatment is started, the simpler it is to treat.

Early Onset Juvenile Scoliosis

Juvenile scoliosis is diagnosed in children between the ages of 3 and 10 years old.Early Onset Juvenile scoliosis is the age group I can often make the biggest impact with, but only if treatment is started prior to the first pubescent growth spurt; remember, scoliosis progression is triggered by growth.

Many children with scoliosis can experience noticeable progression with the first significant growth spurt, but if treatment is applied prior, the curve can be reduced before entering into the growth, counteracting the effect of growth.

There are never treatment guarantees, but non-surgical treatment options are more effective the sooner treatment is started.

Many people ask if childhood idiopathic scoliosis is genetic, particularly parents and/or caregivers of children recently diagnosed.

Is Idiopathic Scoliosis in Children Genetic?

Idiopathic scoliosis doesn't just affect adolescents and adults, but can also affect children as young as 6 months old.

One of the most frequently-asked scoliosis questions is whether the condition is caused by the presence of a specific scoliosis gene, or genetic mutation, that can be passed down from one generation to the next.

While a lot of research has been done on the subject, a specific scoliosis gene has yet to be identified, but then why is scoliosis more common among families, making a family history a risk factor for future generations?

This is where the familial designation comes in; scoliosis is more familial than genetic.

Familial conditions are often multifactorial. Remember, families share a lot more than just their genes. Families share socioeconomic factors, diet, lifestyle, posture, responses to stress, location, and more.

There have also been a number of twin studies conducted that support the familial nature of scoliosis.

And what about scoliosis in children that's not idiopathic?

Childhood Scoliosis Types with Known Causes

As mentioned, idiopathic scoliosis is what 80 percent of scoliosis patients are diagnosed with, but what about the remaining 20 percent?

The remaining 20 percent of scoliosis types are atypical and consist of neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

It's important to determine the type of scoliosis because treatment has to be shaped around a condition's underlying cause, or merely symptoms of scoliosis are being addressed and not the condition itself.

While scoliosis is progressive, it can be highly treatable, particularly with early detection and intervention.

For our current purposes of exploring childhood scoliosis, as degenerative scoliosis affects older adults, we'll focus on the former two types.

Neuromuscular Scoliosis in Children

Neuromuscular scoliosis is caused by the presence of a larger neuromuscular condition like spina bifida, muscular dystrophy, and cerebral palsy.

So these conditions can be particularly severe as the scoliosis developed as a related complication of a larger medical condition; this complicates the treatment plan as the neuromuscular condition has to be the focus of treatment.

Scoliosis diagnosed as neuromuscular is considered atypical not just in terms of its causation, but also in curvature pattern/type.

In cases of typical idiopathic scoliosis, curves bend to the right, away from the heart, but in atypical cases, curves can bend to the left, towards the heart (dextroscoliosis).

When I see a left-bending curve on childhood scoliosis x rays, this is a red flag that I'm dealing with an atypical type of scoliosis that will have unique treatment needs and likely be severe.

As children grow, scoliosis can progress, and as neuromuscular conditions cause a disconnect between the brain and the muscles, connective tissues, and ligaments that support the spine, severe unnatural spinal curves can form.

Some children with neuromuscular scoliosis can become nonambulatory (unable to walk on their own and wheelchair bound).

Pelvic obliquity is common, and some children with neuromuscular scoliosis need future surgery.

Congenital Scoliosis

In cases of congenital scoliosis, babies are born with the condition as it's caused by a malformed spine that develops in utero; this is a rare type affecting approximately 1 in 10,000.

Babies with congenital scoliosis often present with additional congenital abnormalities so have to be comprehensively assessed.

Congenital scoliosis patients have to be monitored for progression, particularly during intense periods of growth, and while non-surgical treatment plans can be modified to address the unique challenges of treating patients of such a young age, these cases can also be severe.

Spinal malformations can include vertebrae forming into one solid bone, instead of separate vertebral bodies, or vertebrae being triangular in shape, when healthy vertebrae are rectangular so the spine can stay aligned and develop its healthy curves.

Conclusion

When it comes to progressive conditions like scoliosis, the best time to start treatment is always now, and as a progressive condition triggered by growth, childhood scoliosis should be taken seriously and treated proactively.

Children have the most to gain from early diagnosis and treatment because they are the most vulnerable to progression due to growth.

As scoliosis progresses, the size of the unnatural spinal curve is increasing, as are the condition's effects, and this means symptoms will become more severe, and when/if scoliosis becomes severe, children can be funneled in the direction of invasive spinal surgery.

The goal of childhood scoliosis treatment here at the Scoliosis Reduction Center® is always to prevent progression and the need for surgical intervention.

With a proactive conservative treatment approach that combines multiple different types of treatment, childhood scoliosis can be highly treatable, and while there are no guarantees, treatment success is directly related to when conditions are diagnosed and addressed.

Knowing the condition's early signs can lead to early detection, and in children, this is most often uneven shoulders and hips; additional postural changes can include an uneven waist line, one shoulder blade being more prominent, a rib cage arch, one hip sitting higher than the other, and these changes are most noticeable when bending forward.

Childhood scoliosis isn't commonly painful as the condition doesn't become compressive until skeletal maturity has been reached, and growing spines are constantly counteracting the compressive force of the unnatural spinal curve with the lengthening motion of growth.

So if you are concerned a child in your life is showing the early signs of scoliosis, they should be assessed as soon as possible so conditions can be diagnosed and treated proactively.