Scoliosis

Scoliosis is a curved deformity of the spine. It may be found incidentally, or may present with symptoms such as back pain. A painful scoliosis is a red flag and referral is needed. 

The photograph below shows a scoliosis - suggested by asymmetrical shoulder height and skin creases. The scoliosis is often more obvious on forward flexion (see pGALS). 

Severe scoliosis is likely to cause cardiopulmonary problems. 

Acute onset painful scoliosis warrants urgent referral (same day) as serious disease such as infection or malignancy is more likely.

Types of scoliosis:

Congenital - related to malformation of the vertebra(e), genetic conditions (such as neurofibromatosis or Spina Bifida).

Neuromuscular - related to conditions (such as Cerebral Palsy and Muscular Dystrophy).

Idiopathic - is further divided by age of onset:

• Infantile – onset 0-3 years.
• Juvenile – onset 4-10 years, or before onset of puberty.
• Adolescent – onset over 10 years, or after puberty;  >90% of cases of Idiopathic Scoliosis

Management depends on the severity of the curve and age of the child. Bracing and occasionally surgery are needed. Scoliosis present before adolescent growth spurt is more likely to progress.