Spine Care

Scoliosis is a lateral, or sideways, curvature of the spine greater than 10 degrees. This also includes types of neuromuscular scoliosis like spina bifida, cerebral palsy, spinal muscular atrophy (SMA) and muscular dystrophy.

Kyphosis refers to the rounding of the upper back in a C-shaped curve, or a hunched back. Kyphosis most commonly affects the thoracic spine (upper and middle back) but can also involve the cervical (neck) and lumbar (lower back) portions. The two most common types of kyphosis are Scheuermann’s kyphosis and postural kyphosis. Kyphosis may develop because of:

• Metabolic problems
• Neuromuscular conditions
• Spina bifida
• Osteoporotic fractures
• Traumatic injuries
• Slippage of vertebral disc

The symptoms of kyphosis may vary based on how severe they are. They may range from a minor change in the shape or appearance of the back to more severe nerve problems and long-lasting back pain. There may be weakness in the legs because of the pressure that is put on the spinal cord and nerve from the spinal curvature. Trouble breathing may also develop because of pressure over the lungs. Evaluations and diagnostic tests may include:

• A complete medical history
• A physical examination by a doctor to evaluate spine movement, muscle strength, and sensation, to help the doctor make a proper diagnosis and also rule out other similar conditions
• Some diagnostic tests, such as X-rays, a magnetic resonance imaging (MRI) scan and a computed tomography (CT) scan, to see the structure of the spine and measure the curve

Kyphosis has several treatment choices that range from medicines to exercises including physical therapy and casts and support braces. Spine surgery may also be considered in some cases.

In cases where osteoporosis causes kyphosis, it’s recommended that your child do the following to slow down the condition’s progress:

• Take vitamin D and calcium supplements.
• Use hormone replacement therapy.
• Exercise regularly.

Spondylolysis, also known as stress fractures, is a defect in the spine at a part of the bone known as the pars interarticularis. This pars region connects the front part of the backbone (vertebral body), which houses the spinal cord and nerves, to the back part of the backbone (posterior elements).

Spondylolysis is caused by genetics, overuse or repeated injuries, or a combination of the three. Children at highest risk to develop these defects are those who join in sports that require children to repeatedly arch their backs. Those sports include gymnastics, cheerleading, weight lifting and football.

Many children are symptom-free, and the condition is often overlooked. However, when spondylolysis has symptoms, it is typically lower back pain, which is made worse because of arching the back. In rare cases, your child could feel pain that goes down the legs. The pain is typically severe enough that your child may not want to join in a sport.

Spondylolisthesis, or a slipped vertebra, is commonly associated with spondylolysis. Spondylolisthesis typically occurs when someone has spondylolysis, and then as a result, one bone slips forward in relation to another.

These two conditions are the most common causes of chronic back pain in children.

At your appointment, your child’s doctor will look for signs of stress fractures by:

• Taking a complete medical history.
• Doing a physical examination.
• Getting an X-ray of the lower back.

Sometimes a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan might be used to look for very small fractures, to rule out other possible causes of pain and to plan treatment options.

A moderate approach will often work to treat spondylolysis, including rest, medication and physical therapy.

Treatment is intended to reduce pain and swelling, which usually allows the fracture to heal. In some cases, a back brace may be worn for a short time to take the pressure off the lower back. If your child’s pain continues, he or she may need surgery.

Trauma injuries to the spine may include spinal fractures and post-traumatic spine problems.

Acute spine injuries happen suddenly. This can be cause from things such as a car accident or a fall.

Burst fractures—thoracic or lumbar spine fractures—generally result from a high-energy impact, such as a car crash, fall from a height or contact sports, that forcefully smashes the spine. The energy of the injury causes the vertebrae to fracture, or burst, into multiple pieces, and the injured vertebrae lose height, which can lead to instability and a deformity and/or injury to the spinal cord.

X-rays of the spine, including upright or standing, are necessary to determine if the spine is stable. A CT or computerized axial tomography (CAT) scan and/or an MRI may be required for a better view of the injury.

Generally, stable burst fractures are treated with braces and pain medication. However, unstable fractures require surgical stabilization to protect the spinal cord from injury and the spine from future deformity. Any fracture-associated spinal cord compression will need surgery to decompress the cord.

Chronic spine injuries are spine injuries that are ongoing. This can be caused by muscle strains and overuse, but constant pain could be a sign of something more serious.

Up to 50% of teens will experience back pain before the age of 20. Most back pain will resolve without treatment. In children age 10 and under, back pain is extremely uncommon unless there is a specific injury. In fact, the most common cause is constipation. If your child or teen has ongoing pain, consider setting up an appointment to be seen by a doctor.

Common sources of back pain in children and adolescents include:

• Overuse/muscle strains
• Stress fractures (spondylolysis)
• Scheuermann’s kyphosis
• Herniated disc
• Backpacks

Childhood back pain can be caused by a variety of issues ranging from normal growing pains to activity-related injuries requiring urgent treatment. Your child needs immediate medical attention if he has any of these symptoms:

• Constant back pain
• Pain that’s only in one specific area
• Pain that requires pain medication
• Pain that limits activities
• Pain associated with fevers, chills and weight loss

In the adolescent age group, back pain is very common and is usually concentrated across the middle of the lower back—and may be noticed especially when sitting or standing for long time periods. You may also notice that your child slouches more often and insists it hurts to sit up straight.

It’s normal for a teen to experience aches right after a growth spurt—muscles typically grow strong before they grow long—but these aches rarely require pain medication or limit activity.

In order to stop the backache, your child may need to build up back and core strength, and a short course of physical therapy may be helpful.

Back pain is an extremely broad topic and may or may not be due to the back itself. Your child’s doctor will complete a physical examination and ask several questions to determine the cause and location of the pain. If necessary, X-rays will be ordered during the initial visit, and then imaging tests and blood work may be recommended at subsequent visits if the cause is still not clear.

Tumors and infections in the bone can include aneurysmal bone cysts, osteoblastoma (sarcoma), histiocytosis, malignant tumors and osteomyelitis.

A unicameral bone cyst, also known as a simple bone cyst, is a benign (not cancerous) bone tumor. These tumors are most commonly found near the shoulder and hip joints. They often go away without treatment after your child has completed the growth cycle.

Bone and joint infections (osteomyelitis and septic arthritis) occur much more commonly in children than in adults, with the majority of cases occurring in children under the age of 5. Our team understands these infections.

Vertebrae problems, or problems with the discs of the spine, can include degenerative disc disease, herniated discs or other disc disorders.

In recent years, disc herniation in children has become more common. A herniated disc develops when one of the discs between the bones (vertebrae) of the spine moves out of position and presses on adjacent nerves, causing pain in the back, pain in one or both legs and numbness, tingling or weakness in one or both legs. These discs are cushions that have a soft center and a hard outside. If the hard part of the disc cracks and the soft part is exposed, it is called a hernia. A herniated disc can also be called a “pinched nerve” or “bulging disc.”

Deformities of the spine or chest can be associated with other conditions, such as Prader-Willi syndrome, Jeune syndrome, congenital rib fusions, Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Rett syndrome, Friedreich’s ataxia, osteogenesis imperfecta and achondroplasia.