The most common cause is cerebral palsy - a syndrome caused by a brain injury within the first two years of life. Children often cannot walk and have developmental delays. Some forms are very mild, while others involve all of the extremities. Scoliosis occurs in approximately 50% of children with cerebral palsy.
Other causes are injuries or syndromes that affect the spinal cord. Spina bifida (a failure of the bony portions of the spine to form properly around the nerves) may cause no abnormalities, or paralysis in the legs. The higher the lesion, the more likely scoliosis will occur. Similarly, gun shot wounds or severe injuries to the spine during growth may cause paralysis and scoliosis.
Observations:
For smaller curves (under 30 degrees), we typically observe the patients with long-cassette xrays every 6 months.
Bracing:
Because this type of scoliosis typically occurs at an early age, bracing and/or wheelchair modifications are very common in curves more than 30 degrees.
Surgery:
Surgery is typically recommended in curves over 45 degrees. However, since this type of scoliosis occurs early in life, we try to help the children grow as much as possible before stabilizing the spine. If the curve grows very quickly or becomes rigid, surgery may be necessary.
The goals of surgery are:
- To prevent the curve from growing further
- To keep the pelvis level and perpendicular to the spine (in children that cannot walk).
Developmental delays are typically noted early in life during routine evaluations with your pediatrician. Spine specialists need to become involved when the spine begins to curve quite a bit. This may lead to the hips to twist.
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Myelomeningocele/Lumbar Kyphosis This is a young woman with thoracic-level spina bifida (myelomeningocele). She cannot use her legs. Because the bones did not close properly around her nerves, the back-straightening muscles are pushed forward. The spine develops severe lumbar kyphosis that may lead to skin breakdown. |
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