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Pediatric Scoliosis and Kyphosis: When is Spinal Surgery Necessary?

Scoliosis and kyphosis are two types of juvenile spine deformities that can affect children. Both scoliosis and kyphosis involve an abnormal curvature of the spine.

Lower back pain, “waddling” while walking, or the development of a “humpback” are typical signs of pediatric spinal deformity. 

Early detection of pediatric spinal abnormalities may improve the efficacy of treatment. Physical therapy and bracing are common conservative treatments for pediatric spinal abnormalities. However, surgery may be required in some cases.

Scoliosis in Children

Scoliosis, or lateral curvature of the spine, typically results from the growth spurt that occurs just before puberty. 

Children’s scoliosis symptoms could include:

  • The head position being off-center
  • Uneven musculature on one side of the spine
  • A protruding rib or shoulder blade
  • Uneven hips, arms, or leg lengths

While the majority of scoliosis instances in children are mild, some grow up with spine deformities that worsen over time.

Most children do not require treatment, although they are regularly monitored to see if the curvature is growing worse. If treatment is necessary, it usually involves the use of a brace to prevent the curvature from getting worse or may involve surgery to accomplish the same goal.

Kyphosis in Children

Kyphosis, sometimes referred to as round back or Kelso’s hunchback, is an over-curvature of the upper back vertebrae.

One of the symptoms of kyphosis is a curved spine, which leads to a back-bowed posture that is typically associated with slouching.

More extreme cases can cause symptoms such as:

  • Acute pain and discomfort
  • Difficulties in breathing and digestion
  • Cardiovascular irregularities
  • Neurological issues

In the most severe cases, kyphosis can significantly shorten the lifespan.

Spinal fusion surgery is nearly always necessary in severe cases since conservative measures typically do not work effectively in these situations.

What causes Scoliosis and Kyphosis?

Though certain cases may develop from physical trauma, cerebral palsy, muscular dystrophy, spina bifida, or spinal muscular atrophy, the reasons for scoliosis are mostly unknown.

Both Kyphosis and Scoliosis can have idiopathic forms, but they also have a range of other causes, including congenital, postural, degenerative, traumatic, and neuromuscular factors. Spina Bifida is a birth defect unrelated to idiopathic kyphosis, although it can increase the risk of scoliosis in some cases.

When is surgery needed for Scoliosis and Kyphosis?

Reducing spinal deformity and preventing the curve’s progression are the main objectives of scoliosis surgery. Children and adolescents are carefully monitored before they are eligible for surgery.

Surgery is advised if:

  • The spinal curve is greater than 40 degrees
  • The patient’s scoliosis appears to be getting worse

Types of Scoliosis Surgery 

Scoliosis surgery can be of different types, such as Spinal Fusion, Posterior Approach, Anterior Approach, Video-Assisted Thoracoscopic Surgery (VATS), Osteotomy, and Vertebral Body Tethering (VBT). VBT is a comparatively new innovation in spinal surgical treatment. VBT’s less invasive technique and reduced complication rate are contributing to its growing popularity.

Conclusion

Scoliosis and kyphosis mostly affect children and adolescents. Most cases of scoliosis are mild and involve careful monitoring. Some of the conservative treatments include physical therapy and bracing. However, if the spine curvature is more than 40 degrees, surgery is typically recommended.

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