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School-age Children and Scoliosis

Diagnosis and the Benefits of Lower-Radiation Imaging

Angela Davis gave her 11-year-old daughter Emily a hug like she had done many times before, but this time something felt different. She noticed that her shoulder blades didn’t feel like they were in the right place. Although Emily had seen her pediatrician six months prior for her regular checkup, her scoliosis wasn’t discovered until she hit a growth spurt. 

Scoliosis is a sideways curvature of the spine that is most frequently diagnosed during adolescence. Sometimes a curve in the spine is easy to see. Other times, scoliosis presents itself in less obvious ways. Emily’s mom noticed her uneven shoulders, which is a common symptom. Others include uneven hips or waist, body leaning to one side, head not centered over the body, one side of the ribcage sticking out, and back pain.

Approximately three percent of adolescents have scoliosis. The exact cause of idiopathic scoliosis, which is the most common type, is unknown (in fact, idiopathic means unknown). We do know that it’s not caused by poor posture, injury, or lugging around heavy backpacks – although avoiding all of these things is certainly good for your child’s back health. Genes appear to be a factor, as scoliosis tends to run in families.

The key to proper treatment of scoliosis is identifying it early, which is why screenings are done routinely during well-child visits to the doctor. Some schools conduct screenings as well. Upon diagnosing Emily’s scoliosis, her pediatrician referred her to an orthopaedic surgeon for ongoing monitoring and treatment. 

Kids with scoliosis receive regular imaging so doctors can track the progress of the condition and make informed decisions about treatment. This frequency, coupled with the large portion of the body that needs to be scanned, can add up to significant amounts of radiation over time. 

For this reason, high-tech, ultra-low-dose EOS imaging is recommended. EOS uses 50 percent less radiation than a standard x-ray, sometimes even less, and provides high-quality, 3D images of the whole body from one scan that lasts only ten to twenty seconds. Because the scans are done standing up, orthopaedic surgeons can see the body’s alignment in its weight-bearing position which provides clear, multi-angle views of the spine and lower limbs and results in an informed assessment of the condition’s impact on the entire body. In addition to scanning for scoliosis, EOS imaging can be beneficial for kids with conditions that cause hip, knee and other lower limb deformities that require regular scans in weight-bearing positions.

Scoliosis can get worse as kids’ bodies continue to grow and change, which is why we monitor it closely. Oftentimes, mild cases of scoliosis don’t need treatment. If the curvature becomes more pronounced, a brace is recommended to prevent it from progressing. While the goal is to avoid surgery, sometimes it’s the best treatment option.

Because of the progression of her scoliosis, Emily ended up going the route of surgery. Her spine was fused in an operation in July 2018, and she was able go back to school six weeks later alongside all of her classmates returning from summer break. 

A couple months ago, Emily reached another milestone – getting back in the saddle and riding her horse again after taking a break from this favorite activity for almost a year. Today, Emily is doing all her normal activities, including starting her eighth grade year and finishing out middle school with her friends. She’ll continue regular office visits, albeit much less frequently. Moving forward, annual EOS scans will keep an eye on her spine. Knowing that these scans are being conducted with the lowest-dose radiation possible will help everyone rest easy. 

Victoria Kuester, MD is an orthopaedic surgeon at Children’s Hospital of Richmond at VCU. Dr. Kuester lives in the city, and enjoys church, the outdoors, and spending time with her husband and two boys.
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