Spinal IssuesYour Child

By Arricca Elin SanSone

As a parent, you’re always attuned to your kid’s health. But should you be worried when your kid complains of back pain? Or maybe you’ve noticed that your child’s shoulders or hips look uneven when wearing a bathing suit. Should that be checked out?

It turns out there are common spinal issues parents should know about so they can seek early treatment. “The most common spinal condition in kids is scoliosis, which is a curvature of the spine,” says David H. Clements III, MD, professor of orthopaedic surgery and neurosurgery and director of the Scoliosis Program at Cooper Bone and Joint Institute at Cooper University Health Care. “We can do a simple exam to look at a child’s spine to see if it’s symmetrical and determine appropriate treatment based on the degree of the curve.” Here’s what else to know about common spinal issues:

Although scoliosis often runs in families, it’s not really known why the Sor C-shaped curve develops. “Scoliosis often appears when kids are around ages 10 or 11, but most kids are so flexible that they’re not even aware of it,” says Clements. “It typically comes on slowly, and kids aren’t usually in pain.” It affects about 2 to 3 percent of the population, but girls are eight times more likely than boys to progress to a curve that requires treatment.

Mark Rieger, MD, a pediatric orthopedic surgeon and the founding partner at The Pediatric Orthopedic Center in Cedar Knolls, says most cases of scoliosis don’t require treatment. “We see a lot of patients who just require observation, fortunately,” Rieger says. “There are fewer surgical cases being done because early intervention is so effective in suppressing curve progression.” Using a comprehensive approach of monitoring by a physician, getting physical therapy, making sure the patient is getting enough vitamin D and calcium, if needed, and early bracing are key.

Scoliosis is usually diagnosed by a physical exam and then confirmed by X-ray. Typically, the curve is monitored by X-ray and exams every six months to see if it’s worsening. At The Pediatric Orthopedic Center, a special EOS X-ray is used which requires far less radiation than a regular X-ray. While mild scoliosis curves don’t need treatment, kids with moderate curves between 25 and 40 degrees and who are still growing may require a brace, which fits under the arms to the hips. “Many studies show that the braces stop curve progression in about 80 percent of kids who wear it as prescribed,” says Clements. It’s typically worn about 16 hours per day but can be removed for activities such as sports.

More severe cases of scoliosis must be treated with surgery. One example is a posterior spinal fusion using what’s called a Firefly instrument that creates precision guides that minimize surgical risk and radiation exposure, Rieger says. Another surgical option is anterior vertebral body tethering, which is up-and-coming, and modulates the growth of the spine, he adds.

Physical therapy (PT) also helps. “PT can help align and stabilize the spine with strengthening exercises,” says Ashley Conklin, DPT, assistant professor, Department of Rehabilitation and Movement Sciences at Rutgers School of Health Professions. “We collaborate with your child’s doctor and orthotist, who fits the brace, to tailor PT to the child’s specific needs.”

Kyphosis is a forward-bending of the spine, resulting in a rounding of the upper back. It’s also diagnosed by exam and X-rays. “It’s a postural issue, which I see in kids who are constantly bending forward and looking at their phones,” says Clements. It can be seen at any age but is more common in adolescent females. Fortunately, postural kyphosis can be corrected with stretching and strengthening exercises.

Rarely, kids may be diagnosed with Scheuermanns kyphosis, which becomes apparent during the teen years. It may cause back pain and is due to a structural deformity, not poor posture, so X-rays will show consecutive vertebrae with a triangular, instead of the normal rectangular shape. According to the American Academy of Orthopaedic Surgeons, PT also may relieve pain and improve posture from this type of kyphosis. Some kids also may benefit from bracing.

These are two conditions diagnosed by exam and X-ray. “Spondylosis is a crack in the part of the vertebrae which is thin and ‘plastic’ in a kid’s spine,” says Clements. “This part doesn’t harden up until adulthood, so it can fracture with repetitive stress. It’s especially common in kids who participate in sports in which they’re leaning backwards a lot, such as gymnastics.”

The crack may cause the vertebrae to shift or slip forward, which is called spondylolisthesis. Slippage often occurs during periods of rapid growth. Kids may have no symptoms or, with severe slips, they may experience lower back or leg pain, says Clements. Treatments may include limiting activities to allow healing, a back brace, and PT.

Fortunately, not all back pain is related to a genetic or structural issue with the spine. Carrying a heavy backpack is a common cause of back pain. Clements says kids should carry less than 10 pounds in their bags. “Learning some basic stretches, reducing screen time, and moving more relieves back pain in many of the children I treat,” Clements says.

If you’re concerned about a potential issue, have your child assessed. An awareness of common spinal conditions, along with early intervention, PT and exercise can help promote more positive outcomes with back issues at any age.