Spinal deformity and scoliosis can be found at birth due to genetic causes, develop during childhood, or develop late in life because of degenerative disc and joint disease. Common signs of scoliosis are a prominent shoulder or shoulder blade, or chest wall asymmetry. Another sign is uneven hips, with one hip seemingly higher than the other hip. It is important not to confuse scoliosis with poor posture and to realize that scoliosis will usually not disappear with age. In spite of the severity of these conditions and the impact they have on the lives of children, the prevalence of spinal deformities in children under the age of 18 years is difficult to determine because of relatively low numbers and the degree to which the condition manifests initially in pain or disability. Estimated prevalence of spinal deformity conditions has been cited in numerous studies, and ranges from 1 in 1,000 for congenital scoliosis to 68 in 100 for adult spinal deformity or scoliosis for persons age 60 years and older. (Reference Table 3.1.3 PDF CSV)
There are several different types of scoliosis. The most common type of scoliosis is idiopathic, meaning the cause of is unknown. Approximately 80% to 85% of scoliosis cases are idiopathic.1 Idiopathic scoliosis can initially occur as early as the first three years of life, which is known as infantile idiopathic scoliosis. If diagnosed between the ages of 4 to 10 years, it is known as juvenile idiopathic scoliosis, and from 10 years of age to skeletal maturity, as adolescent idiopathic scoliosis. Adolescent idiopathic scoliosis is the most common type.
Scoliosis, if severe enough (>25°), is usually treated with bracing if the child is growing, or with surgery if the curvature is more severe (>45° to 50°). The standard radiograph measurement method for all forms of scoliosis is the Cobb angle measurement technique, measured from the end plates of the maximally tilted end vertebral bodies in a standing radiograph.2 Whether the curve is >25° or >40° to 45°, the treatment is preventative in nature, helping to avoid progression of the curve and more significant future problems that might occur if it was left untreated. While this preventative aspect is hugely valuable and intuitively important, its benefit is difficult to measure from a public health standpoint, especially for rare conditions of childhood such as juvenile and adolescent pediatric scoliosis.
- 1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Questions and answers about scoliosis in children and adolescents. National Institutes of Health, U.S. Department of Health and Human Services, 2007. Available at: http://www.niams.nih.gov/Health_Info/Scoliosis/default.asp. Accessed December 20, 2014.
- 2. Herzenberg JE, Waanders NA, Closkey RF, et al: Cobb angle versus spinous process angle in adolescent idiopathic scoliosis: The relationship of the anterior and posterior deformities. Spine 1990;15:874-879.