UNWANTED CURVES
Middle school screening can catch scoliosis, but it may take more drastic measures to fix it

The spine is – how else can we say it? – the backbone of the human body, enabling us to walk, run, jump, and play sports. That’s why it may surprise some parents whose kids can do all those things that those same children might still have something wrong with their spines, namely a curvature known as scoliosis.

Scoliosis is a lateral (side-to-side) curvature of the spine of more than 10 degrees (the word comes from the Greek word for “crooked”). Three types have been identified: idiopathic, congenital, and muscular. Congenital and muscular scoliosis typically reveal themselves when a child is small, while idiopathic scoliosis is more commonly discovered during the middle school years.

“Idiopathic scoliosis is found all over the world, and it’s the same everywhere,” explains retired orthopedic spinal surgeon Dr. Robert Winter, an original founder of the Twin Cities Spine Center. “It occurs mostly in girls, it can be hereditary, and it’s typically found in three out of every 100 children.”

Idiopathic scoliosis is often first discovered at school screenings when health officials conduct simple bending tests to assess whether a child’s spine has a curve. Winter, who created Minnesota’s screening program in the late 1960s, says children often have straight spines until they reach age 10, when they begin to curve – which is why middle schools routinely monitor students for changes. “These aren’t kids who were born with a curvature,” explains Winter. “Their spines were straight until age 9 or 10. This is what mystifies parents because, in every other way, they have a perfectly healthy kid.” What mystifies both doctors and parents alike is the fact that idiopathic scoliosis is dominantly a female problem: Winter estimates that 90 percent of cases are found in girls.

When a curvature is found, treatment can vary depending on the degree of the curvature. For curvatures less than 20 degrees, most doctors monitor any changes carefully to see if the curvature gets worse over time. Many don’t.

“To put a brace on a back with a 14 degree curve would be overtreatment. Fourteen degrees we can live with,” says Winter. Around 20 degrees, if a child still has growing left to do, bracing is the best option. Braces are custom made to help right a child’s specific curvature (curves can be in the lower or upper back and bend to the left or right) and are worn at least 22 hours a day.

“That’s a hard thing for a teenage girl to hear, which is why 50 percent of the job is being a doctor and 50 percent is being an adolescent psychologist,” explains Winter.

The best way to help children cope with the newfound condition and brace is to introduce them to other children facing the same situation. “Everyone feels like the only person in the world who has [ever had] to wear a brace the first time they hear about it,” says Winter. “But if a girl comes into a clinic and sees nine other girls smiling and chatting and surviving life with the brace, they realize they can do it, too.”

Of those who wear the brace until they finish growing, Winter says 50 percent see their condition either improve or stabilize – which isn’t a number that impresses a lot of parents. “Can we guarantee the brace will work? No. Like most things in life there’s no 100 percent guarantee. But if a patient goes in with a 28 degree curvature and it’s the same when that patient is done growing, we’re totally happy.”

For those who don’t see changes, the next step is surgery. And while a back still might not look overly crooked to the naked eye, Winter says surgery at this point is to alleviate problems on the horizon. “Surgery is for the future,” he says. “Scoliosis can cause pain, shortness of breath, and the older you get, the harder it is to get a good result from surgery.” Many parents can take such a diagnosis hard, and Winter says the best thing for parents to do is realize that scoliosis can happen to anyone. “I reassure parents that they didn’t do anything wrong; it’s not their fault. This just happens.”

Monica Wright is Minnesota Parent’s staff writer.

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