A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an "S" or "C" and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater.
In over 80 percent of cases, the cause of scoliosis is unknown — a condition called idiopathic scoliosis.
In this segment, Munish Gupta, MD discusses idiopathic scoliosis and when a pediatrician should refer a patient to St. Louis Children's Hospital.
Selected Podcast
Idiopathic Scoliosis in Children
Featured Speaker:
Learn more about Munish Gupta, MD
Munish Gupta, MD
Munish Gupta, MD, is a Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital.Learn more about Munish Gupta, MD
Transcription:
Melanie Cole (Host): A normal spine, when viewed from behind appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature that might be considered large enough to require treatment. Adolescent idiopathic scoliosis is by far the most common type of scoliosis affecting children between the ages of 10 to 18. My guest today is Dr. Munish Gupta. He’s a Washington University, a pediatric orthopedic spine surgeon at Saint Louis Children’s Hospital. Welcome to the show, Dr. Gupta. What is idiopathic scoliosis?
Dr. Munish Gupta (Guest): Idiopathic scoliosis is a designation given to patients with a curvature on their spine that goes from side-to-side, where we do not know what causes the scoliosis. That’s why it’s called idiopathic scoliosis.
Melanie: So is there a genetic connection with this? Is there a genetic component?
Dr. Gupta: Yes, there is a lot of research being done where they have identified multiple genes that could be related to causing scoliosis, but there’s no single gene that has been associated with scoliosis.
Melanie: Dr. Gupta, when would this first be realized? Would the parents notice it when they’re a baby or is it something that as the bones are in ossification and the spine is developing that that’s when it starts to appear?
Dr. Gupta: Scoliosis is a very common symptom. It can be there when the kid is born, and that would be more of a congenital scoliosis case, but sometimes scoliosis can appear when you’re young, even in the infantile stage, so there’s many ages where it can appear, but the most common scoliosis is really the adolescent idiopathic scoliosis that we usually see scoliosis in teenagers. That’s the one where it’s discovered when patients are going through a growth spurt, so frequently a pediatrician will have them bend forward and look for asymmetry in their ribs and will notice scoliosis and refer them to us.
Melanie: So if they notice a little bit of a curvature, a lateral curve, is that when you would like them to be referred to an orthopedic spine surgeon, or what would be the next step for a pediatrician?
Dr. Gupta: If they notice an asymmetry of the ribs, that is a time to refer to an orthopedic surgeon who specializes in pediatric spine to figure out what is this scoliosis caused from and also if there is something that needs to be done in terms of treating the scoliosis.
Melanie: So then tell us what you would do, after the pediatrician has done the postural screening exam and if they are referred then to you, what do you do as far as an evaluation?
Dr. Gupta: So the first thing is we ask for the history. Since it is hereditary, the mothers can pass it on to their children usually, so we ask for their history, and then we also ask for any other kinds of signs that they may have in terms of pain or neurologic complaints, and then we examine them and then to look at the deformity. The most important thing is getting a radiograph to look at the vertebral bodies and the spine itself to look at the extent of the curvature. If they have abnormal bodies, it’s usually congenital scoliosis, but if they have normal appearing bodies, but they have a lot of rotation and lateral deviation with the curve, then it’s usually idiopathic scoliosis.
Melanie: And how do you measure growth potential?
Dr. Gupta: Our growth potential judgment is from their history -- whether they have the onset of their periods, that tells us where they are in terms of their hormonal maturity and how much growth they have left because most of the peak growth is done before they have their periods. That’s one, and the second is with radiographs. We have certain markers on the iliac crests, or hands and wrist to look at the growth plates to see if they still have the potential to grow and how much growth is left.
Melanie: And then if a patient is referred to you then what are some treatment options that might be available and what would you like other pediatricians to know about being involved in this?
Dr. Gupta: So, the first thing that pediatricians should know is it’s better to refer them early than wait until the curve gets really severe because when we see the cases early on, we usually have three options to treat scoliosis. One is by observation where we can do serial physical exams or serial radiographs. The second is if there is some progression, we can brace them and the brace will work 70% of the time if used 18 hours a day. And then finally, the curve is so severe that bracing is not an option, then we use surgery as the option.
Melanie: So tell us a little bit about the brace. If a child is in a brace, would they continue to see their pediatrician? Would there be any difference in those annual visits?
Dr. Gupta: When they’re in a brace we usually monitor them every six months, and if they have any other problems, of course, they’ll see their pediatrician and if there’s any other issues, but usually every six months suffices for the follow-up. Bracing is not the end of the world. We still allow them to do sports activities and we only ask them to wear it 18 hours a day, so they have six hours off. Life is not over just because you’re being braced.
Melanie: And what about things like the preparticipation physical that they might have to take if they do want to participate in some school activities, and the brace, does it come off for these things? What do you tell the school and other pediatricians?
Dr. Gupta: So what I tell the parents, the patient as well as the school, is that to make sure that the patient doesn’t miss out on life and sports. If they are active in sports, they should take if off for sports because it’s healthier for the muscles and the spine to be active and use their muscles and be strong. They can take if off for any kind of sports activity -- they can take if off and put it back on because we have that 18-hour suggestion, so if they have it for 18 hours, that six hours off can be used for sports.
Melanie: And then if you do have to do surgery, what’s involved?
Dr. Gupta: In surgery, it’s only reserved for less than 1% -- I’m sorry, less than 1 in 1000, where they have more than 40 degrees or 50 degrees. What we do is -- since the curvature of the spine is out of control, it’s progressing -- what we do is we put screws and rods, and we straighten the curve out, and we roughen up the bone, and we put bone grafts, and the spine becomes one piece of bone, or it fuses together. That’s what a spine fusion is.
Melanie: And how is the patient affected in the long-term, Dr. Gupta?
Dr. Gupta: Well, I’ll tell you that scoliosis, the majority of the time, the adolescent idiopathic scoliosis, does not affect their lifespan. Once it gets to big degrees – 80 or 100 degrees – it can affect their lungs because the chest is deformed and they get restrictive lung disease. If it’s really severe and the lungs get really affected badly, then the heart can be affected, but in the normal case of adolescent idiopathic scoliosis, lifespan is not affected.
Melanie: So then just wrap it up for is, in the last few minutes, Dr. Gupta, in what you want other pediatricians to know about referral and about idiopathic scoliosis, recognizing these signs and symptoms, and when to refer?
Dr. Gupta: So the first thing is that when you see a patient with asymmetry of their ribs, their hips, their shoulders, and you can see scoliosis is to get them to an expert to see what can be done or needs to be done and to prevent it from getting a lot worse. The worst thing is just to keep watching it, and it gets worse, and then the patient does not have an option to have a non-operative treatment and then we have to go to surgery itself.
Melanie: And tell us about your team. Why is Saint Louis Children’s Hospital so great to work with?
Dr. Gupta: As you know, Saint Louis Children's Hospital is an internationally well-known hospital for their expertise in orthopedics and spine. We have from simple cases to very, very difficult cases. We have a large team of surgeons, ICU docs, OR anesthesiologists, that are very, very highly trained and are used to having these severe cases operated on here, so that strong team and the care that the nurses and the staff gives, makes the surgery easier and also the recovery much better for the patient.
Melanie: Thank you, so much, for being with us today. A physician can refer a patient by calling Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with Saint Louis Children’s Hospital, and for more information on resources available at Saint Louis Children’s Hospital, you can go to SaintLouisChildrens.org, that’s SaintLouisChildrens.org. This is Melanie Cole. Thanks, so much, for listening.
Melanie Cole (Host): A normal spine, when viewed from behind appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature that might be considered large enough to require treatment. Adolescent idiopathic scoliosis is by far the most common type of scoliosis affecting children between the ages of 10 to 18. My guest today is Dr. Munish Gupta. He’s a Washington University, a pediatric orthopedic spine surgeon at Saint Louis Children’s Hospital. Welcome to the show, Dr. Gupta. What is idiopathic scoliosis?
Dr. Munish Gupta (Guest): Idiopathic scoliosis is a designation given to patients with a curvature on their spine that goes from side-to-side, where we do not know what causes the scoliosis. That’s why it’s called idiopathic scoliosis.
Melanie: So is there a genetic connection with this? Is there a genetic component?
Dr. Gupta: Yes, there is a lot of research being done where they have identified multiple genes that could be related to causing scoliosis, but there’s no single gene that has been associated with scoliosis.
Melanie: Dr. Gupta, when would this first be realized? Would the parents notice it when they’re a baby or is it something that as the bones are in ossification and the spine is developing that that’s when it starts to appear?
Dr. Gupta: Scoliosis is a very common symptom. It can be there when the kid is born, and that would be more of a congenital scoliosis case, but sometimes scoliosis can appear when you’re young, even in the infantile stage, so there’s many ages where it can appear, but the most common scoliosis is really the adolescent idiopathic scoliosis that we usually see scoliosis in teenagers. That’s the one where it’s discovered when patients are going through a growth spurt, so frequently a pediatrician will have them bend forward and look for asymmetry in their ribs and will notice scoliosis and refer them to us.
Melanie: So if they notice a little bit of a curvature, a lateral curve, is that when you would like them to be referred to an orthopedic spine surgeon, or what would be the next step for a pediatrician?
Dr. Gupta: If they notice an asymmetry of the ribs, that is a time to refer to an orthopedic surgeon who specializes in pediatric spine to figure out what is this scoliosis caused from and also if there is something that needs to be done in terms of treating the scoliosis.
Melanie: So then tell us what you would do, after the pediatrician has done the postural screening exam and if they are referred then to you, what do you do as far as an evaluation?
Dr. Gupta: So the first thing is we ask for the history. Since it is hereditary, the mothers can pass it on to their children usually, so we ask for their history, and then we also ask for any other kinds of signs that they may have in terms of pain or neurologic complaints, and then we examine them and then to look at the deformity. The most important thing is getting a radiograph to look at the vertebral bodies and the spine itself to look at the extent of the curvature. If they have abnormal bodies, it’s usually congenital scoliosis, but if they have normal appearing bodies, but they have a lot of rotation and lateral deviation with the curve, then it’s usually idiopathic scoliosis.
Melanie: And how do you measure growth potential?
Dr. Gupta: Our growth potential judgment is from their history -- whether they have the onset of their periods, that tells us where they are in terms of their hormonal maturity and how much growth they have left because most of the peak growth is done before they have their periods. That’s one, and the second is with radiographs. We have certain markers on the iliac crests, or hands and wrist to look at the growth plates to see if they still have the potential to grow and how much growth is left.
Melanie: And then if a patient is referred to you then what are some treatment options that might be available and what would you like other pediatricians to know about being involved in this?
Dr. Gupta: So, the first thing that pediatricians should know is it’s better to refer them early than wait until the curve gets really severe because when we see the cases early on, we usually have three options to treat scoliosis. One is by observation where we can do serial physical exams or serial radiographs. The second is if there is some progression, we can brace them and the brace will work 70% of the time if used 18 hours a day. And then finally, the curve is so severe that bracing is not an option, then we use surgery as the option.
Melanie: So tell us a little bit about the brace. If a child is in a brace, would they continue to see their pediatrician? Would there be any difference in those annual visits?
Dr. Gupta: When they’re in a brace we usually monitor them every six months, and if they have any other problems, of course, they’ll see their pediatrician and if there’s any other issues, but usually every six months suffices for the follow-up. Bracing is not the end of the world. We still allow them to do sports activities and we only ask them to wear it 18 hours a day, so they have six hours off. Life is not over just because you’re being braced.
Melanie: And what about things like the preparticipation physical that they might have to take if they do want to participate in some school activities, and the brace, does it come off for these things? What do you tell the school and other pediatricians?
Dr. Gupta: So what I tell the parents, the patient as well as the school, is that to make sure that the patient doesn’t miss out on life and sports. If they are active in sports, they should take if off for sports because it’s healthier for the muscles and the spine to be active and use their muscles and be strong. They can take if off for any kind of sports activity -- they can take if off and put it back on because we have that 18-hour suggestion, so if they have it for 18 hours, that six hours off can be used for sports.
Melanie: And then if you do have to do surgery, what’s involved?
Dr. Gupta: In surgery, it’s only reserved for less than 1% -- I’m sorry, less than 1 in 1000, where they have more than 40 degrees or 50 degrees. What we do is -- since the curvature of the spine is out of control, it’s progressing -- what we do is we put screws and rods, and we straighten the curve out, and we roughen up the bone, and we put bone grafts, and the spine becomes one piece of bone, or it fuses together. That’s what a spine fusion is.
Melanie: And how is the patient affected in the long-term, Dr. Gupta?
Dr. Gupta: Well, I’ll tell you that scoliosis, the majority of the time, the adolescent idiopathic scoliosis, does not affect their lifespan. Once it gets to big degrees – 80 or 100 degrees – it can affect their lungs because the chest is deformed and they get restrictive lung disease. If it’s really severe and the lungs get really affected badly, then the heart can be affected, but in the normal case of adolescent idiopathic scoliosis, lifespan is not affected.
Melanie: So then just wrap it up for is, in the last few minutes, Dr. Gupta, in what you want other pediatricians to know about referral and about idiopathic scoliosis, recognizing these signs and symptoms, and when to refer?
Dr. Gupta: So the first thing is that when you see a patient with asymmetry of their ribs, their hips, their shoulders, and you can see scoliosis is to get them to an expert to see what can be done or needs to be done and to prevent it from getting a lot worse. The worst thing is just to keep watching it, and it gets worse, and then the patient does not have an option to have a non-operative treatment and then we have to go to surgery itself.
Melanie: And tell us about your team. Why is Saint Louis Children’s Hospital so great to work with?
Dr. Gupta: As you know, Saint Louis Children's Hospital is an internationally well-known hospital for their expertise in orthopedics and spine. We have from simple cases to very, very difficult cases. We have a large team of surgeons, ICU docs, OR anesthesiologists, that are very, very highly trained and are used to having these severe cases operated on here, so that strong team and the care that the nurses and the staff gives, makes the surgery easier and also the recovery much better for the patient.
Melanie: Thank you, so much, for being with us today. A physician can refer a patient by calling Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with Saint Louis Children’s Hospital, and for more information on resources available at Saint Louis Children’s Hospital, you can go to SaintLouisChildrens.org, that’s SaintLouisChildrens.org. This is Melanie Cole. Thanks, so much, for listening.