Paediatric Scoliosis

The Specialists at Harbour Spine Centre offer a comprehensive care and management plan for children diagnosed with scoliosis. We understand the anxiety that accompanies a diagnosis of scoliosis and provide early appointments for children to see our Specialists.

What is scoliosis?

Scoliosis is abnormal curvature of the spine, commonly arising in teenagers around puberty.

How do I know my child has scoliosis?

Parents or children often become aware of curvature of the spine due to prominence of a shoulder or hip. Pain in not a typical feature of scoliosis, although some children may complain of discomfort. Sometimes a prominence of the ribs may be seen or felt.

What do I do if I think my child has scoliosis?

If there is concern about curvature of the spine, see your General Practitioner as soon as possible. Your General Practitioner will likely organize referral to a Scoliosis Specialist for further advice.

The majority of children with scoliosis do not require treatment and their curves don’t progress. However, they need to be monitored in case progression occurs and special treatment is required.

How do I make an appointment to see a Scoliosis Specialist?

Call Harbour Spine Centre on (02) 9057 2450 to make an appointment with one of our Paediatric Scoliosis Specialists, Dr. Randolph Gray or Dr. Nathan Hartin.

Does it matter whether we have private health insurance?

All children are seen early at our Sydney locations, regardless of insurance status.

Dr Hartin and Dr Gray are part of the Scoliosis Unit at the Children’s Hospital at Westmead, where children with and without insurance may undergo surgery.  Children with insurance might also have the option to undergo surgery at our affiliated private hospitals.

Are there different types of scoliosis?

Yes, scoliosis is classified according to its cause and behavior.

The most common type of scoliosis arises in healthy teenagers for reasons that are poorly understood – it is called Adolescent Idiopathic Scoliosis (AIS).

Other types include scoliosis due to abnormalities present at birth (Congenital Scoliosis), neuromuscular diseases (Neuromuscular Scoliosis) or other clinical syndromes (Syndrome-associated Scoliosis).  When scoliosis is diagnosed under the age of 10, it’s called Early Onset Scoliosis (EOS).

What is Adolescent Idiopathic Scoliosis?

Adolescent Idiopathic Scoliosis (AIS) is abnormal curvature of the spine with vertebral rotation, which appears in otherwise healthy children aged 10-16.  The severity of the curve is conventionally measured on a front-on xray – the angle is called the Cobb angle.

The rotation of the spine causes asymmetry of the chest wall, shoulders, flanks and hips.

Minor scoliosis is common – 2% of the population have curves more than 10 degrees.  However only 0.25% progress to the point where treatment is required.

Girls are more often affected – the female : male ratio of curves more than 20 degrees is 5:1.

What are the long term effects of Scoliosis?

More and more is known about AIS over time.  Early on, various scientific studies were published which suggested scoliosis led to high levels of disability, back pain and impairment of heart or lung function.  

More recent and comprehensive research has dispelled many of these myths.  A series of studies from Iowa has shown that, for most, AIS is a benign condition that does not require any active treatment. There are higher levels of back pain and cosmetic concerns amongst those affected, but these problems are rarely disabling.  Only patients with severe curves greater than 90 degrees were at risk of heart or lung problems.  Social function is no different to the general population.

What investigations should my child have?

The investigation of choice for scoliosis is an EOS scan. Our office will organize this scan, if required, when your appointment is made. CT scan are not recommended due to the radiation exposure involved.

How is scoliosis treated?

Observation, bracing and surgery are the three main treatment modalities available for the management of AIS.  Scoliosis curves between 10 and 20 degrees are generally managed with observation.  Serial radiographs and clinical review every 4 to 6 months is recommended until growth is completed. 

Bracing

In a child who is still growing, curves in the range of 20 to 40 degrees may be considered for bracing. A brace is a plastic device applied to the body, which attempts to straighten the spine and influence its growth.

The decision to brace is always difficult for the patient and the treating doctor. The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), published in 2013, provided the first high-quality evidence that bracing decreases the progression of high-risk curves in patients with AIS.  It also demonstrated that longer hours of brace-wear were associated with greater benefit.

Surgery

The most severe curves might be recommended for surgery.  The aims of surgery are to restore spinal balance and prevent progressive deformity over time.  Surgery often has cosmetic benefit, although improvement cannot be guaranteed.  Surgery aims to restore balance with the minimum number of fused segments, maintaining as much spinal motion as possible.

Surgical treatment of scoliosis has evolved over the last three decades.  Modern rod-and-screw constructs have provided a powerful mechanism for correcting spinal deformity.

When is surgery recommended in AIS?

Many factors might affect the surgeons decision to offer surgery.  Thoracic curves would generally exceed 50 degrees before surgery is considered.  Thoracolumbar curves might be recommended for surgery at 40 degrees, if they affect spinal balance.