What you need to know about scoliosis
When Scott Szela was younger, his scoliosis was caught during a routine school screening.
At the time, a school nurse or a gym teacher would look at students’ backs to check if their rib cages were uneven, according to Szela. They were looking for scoliosis, a curvature of the spine that bends to the side. Many schools have stopped screenings because of a high number of false positive results, Szela said.
His was not a false positive; Szela was diagnosed with scoliosis. Though he did not need treatment, just observation, his experience along with other factors drove him to pursue a career as a chiropractor with a focus on structural chiropractic and scoliosis. Szela now practices at Chiropractic Works and the Scoliosis Center of New Hampshire in Hudson.
Pediatricians and parents usually see the signs of scoliosis first, he said.
“A parent might notice something like a postural imbalance,” Szela said. “One shoulder might look higher than the other.”
In the United States between six million and nine million people are estimated to have scoliosis, according to the American Association of Neurological Surgeons. Most cases begin to show up between the ages of 10 and 15.
Pediatricians check for signs of scoliosis visually and sometimes with a scoliometer, a device slid along the spine while a child is bent over. The only “definitive way,” to diagnose scoliosis, however, is with an X-ray, Szela said.
Scoliosis progresses with growth spurts in height, Szela said, and it can run in families, usually on the mother’s side.
While treatment is needed in some cases, he said many times it is not needed. Intervention may be necessary if a curve is directly jutting into the ribcage, affecting the lungs, or if posture is causing self-esteem issues.
Doctors will often choose to watch and wait, looking for a progression in the curve over time, Szela said. Treatment can include bracing, which involves the patient wearing a brace designed to slow the growth of the curve. If a curve is severe enough, surgery to stop the curve from progressing can be performed.
“It is a very major surgery,” Szela said. “They open up the entire back.”
In his office, he uses a flexible elastic bracing, which allows patients to continue with their normal activities. The flexible bracing is less rigid than some other types of bracing used to treat the curvature. Another alternative treatment patients can use is physical therapy.
No matter what the treatment, Szela said, it is best to start as soon as possible.
“The more treatment you can do earlier during that growth phase, the better, he said, ”Once you are done growing the bone is done growing and the curve is going to be stable where it is until much later in life.”
Keith Loud, a physician at Dartmouth -Hitchcock in Lebanon who practices adolescent and sports medicine, said treatment for scoliosis needs to be managed over time. With growth, a curve will change and can get worse, and a general rule of thumb is once a curve gets past 45 to 60 degrees it will require surgery.
“Those curves are so severe they can continue into adulthood and get into heart and lungs.”
Curves that are less severe may get better on its own over time, Loud said. Treatment is individualized and depends on how much growing a child has left and to what degree the curve is.
“The physician needs to put it into perspective the size of the curve and the growth rate,” he said.
Two children with the same degree of curve, who are the same age, might be treated very differently because their rate of growth may not be the same. “It’s highly individualized, “ Loud said.
Andrea Bushee is a freelance writer and mom to three children in Pembroke.