Pediatric Spinal Deformities

Spinal conditions such as scoliosis (curving of the spine), kyphosis (increasing roundback of the spine), spondylolysis (stress fracture of the spine), and spondylolisthesis (movement of one part of the spine on another part) may affect children during their early or late childhood years. The majority of spinal disorders do not require bracing or surgery although regular checkups are needed to ensure that the condition does not worsen.

Emory surgeons may use a combination of bracing and spinal casting to prevent your child from needing spinal surgery. When your child's physician feels that non-operative management is no longer appropriate, he may recommend a spinal fusion. While the specifics of the procedure will be discussed by your child's doctor, spinal fusion most commonly involves the placement of screws, hooks, and rods in the spine in order to prevent the deformity from worsening and perhaps even improve the appearance. Emory pediatric orthopedic surgeons have a great deal of experience treating children with all types of spinal conditions, from mild to the most severe.

Pediatric Scoliosis

Pediatric Scoliosis X-RayScoliosis, or a curvature of the spine, is a condition that affects almost 7 million people in the U.S. While it does occur in adults, it is most commonly seen in children, especially girls, during periods of growth. Often times the spine in a person with scoliosis looks like an “S” or a “C” instead of a straight line.

Adolescent scoliosis is the most common spinal deformity affecting pre-teens and teenagers, however it does not always result in significant pain or discomfort. Scoliosis may also occur in younger children and is often referred to as early onset scoliosis (EOS) in children less than five years old. EOS may significantly worsen as the children grow and cause severe spinal deformity and problems with the lungs or other internal organs.

Signs & Symptoms of Pediatric Scoliosis

• Uneven musculature on one side of the spine
• Uneven hips, shoulders, or legs
• Difference in the chest or breast area
• Slowed nerve action (in some cases)

Causes of Pediatric Scoliosis

About 65% of scoliosis cases are from unknown causes. Congenital scoliosis (caused by abnormally shaped vertebrae) accounts for about 15% and the rest is perhaps caused by neuromuscular disease. Some researchers think genetics may play a role in who develops scoliosis, but it is not completely understood at this point.

Pediatric Scoliosis Treatment

Pediatric Scoliosis After Surgery X-RayOur pediatric orthopedic surgeons specialize in treating our younger patients (under 21 years of age) with all forms of scoliosis and other spinal disorders. Our extensive experience in spinal bracing and casting provides patients with nonsurgical alternatives for scoliosis to prevent or delay surgery. Some pediatric scoliosis patients, however, will require surgery to prevent long term problems with the spine, lungs, or other organs.

Surgical Treatment Options

Surgery may be indicated for larger or progressively worsening scoliosis. Surgery options include growing spine instrumentation such as growing rods or the Vertical Expandable Prosthetic Titanium Rib (VEPTR) in younger patients or spinal fusion in older teenagers and young adults. These procedures are designed to stop the scoliosis from progressing, decrease the size of the curvature, and get patients back to their activities as quickly as possible. The majority of patients who have scoliosis surgery are able to get back to their normal activities, including athletics, in just a few months. Meet our pediatric spine doctors.


Our Pediatric Scoliosis Research

Lumbar curve is stable after selective thoracic fusion for adolescent idiopathic scoliosis: a 20-year follow-up
Larson AN, Fletcher ND, Daniel C, Richards BS.Spine (Phila Pa 1976). 2012 May 1;37(10):833-9. 

Current treatment preferences for early onset scoliosis: a survey of POSNA members
Fletcher ND, Larson AN, Richards BS, Johnston CE.J Pediatr Orthop. 2011 Apr-May;31(3):326-30. 

Residual thoracic hypokyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications
Fletcher ND, Hopkins J, McClung A, Browne R, Sucato DJ.Spine (Phila Pa 1976). 2012 Feb 1;37(3):200-6. 

Pediatric Spondylolysis and Spondylolisthesis

The most common cause of low back pain in adolescent athletes that can be seen on X-ray is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis. It usually affects the fifth lumbar vertebra in the lower back.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis. If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

Symptoms
Some sports, such as gymnastics, weight lifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. In either case, the result is a stress fracture on one or both sides of the vertebra.
• Pain usually spreads across the lower back and may feel like a muscle strain.
• Spondylolisthesis can cause spasms that stiffen the back and tighten the hamstring muscles, resulting in changes to posture and gait.
• If the slippage is significant, it may begin to compress the nerves and narrow the spinal canal.

Pediatric Kyphosis

Some degree of rounded curvature of the spine is normal. The term kyphosis is used to describe the spinal curve that results in an abnormally rounded back.

A visit to the doctor is typically brought on by a scoliosis screening at school, a child's or parent's concern about the cosmetic deformity of a rounded back, or pain. X-rays will measure the degree of the kyphotic curve. A kyphotic curve that is more than 50° is considered abnormal.

Types of Kyphosis:
• Postural
• Scheuermann’s
• Congenital

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