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Ask Dr. K: Did you know mild scoliosis usually requires little treatment?

DEAR DOCTOR K: My granddaughter has scoliosis. What is the best treatment option for this condition?

DEAR READER: For readers who may not be familiar with the condition, I’ll start by explaining what scoliosis is. Normally, when you look at a person’s spine, it appears straight. With scoliosis, the spine typically curves out to one side and then back again. Or it may have two bowed-out areas, resembling an S shape. (I’ve put an illustration of a normal spine and a spine curved by scoliosis on my website, AskDoctorK.com.)

What causes scoliosis? Certain neurological conditions, such as cerebral palsy, can cause the muscles of the back to pull unevenly on the bones of the spine. Birth defects in the bones of the spine can cause it. Other genetic conditions that affect the ligaments and soft tissues of the spine also can cause it. In most cases, there is no such clear cause.

How common is scoliosis? Including its mildest forms, about three out of every 100 children are affected. However, in only about three out of every 1,000 children is it severe enough to require treatment.

Scoliosis is a long-term condition that can worsen over time. Most cases begin well after birth, usually in adolescence (although the condition can begin at younger ages). Affected children typically are born with a straight spine, but very slowly the spine starts to curve.

The abnormal position of the spine can affect the development of associated muscles and ligaments, causing the ribs and pelvis to twist and rotate to the side. As a result, a person with scoliosis may have uneven shoulders, a pelvis that thrusts forward on one side, or one leg that appears shorter than the other.

Treatment depends on several factors. These include the child’s age and gender, how severely the spine is curved and where the curve is located. Treatment in girls also depends on whether they have started to menstruate. That’s because scoliosis usually doesn’t worsen once rapid bone growth ends after puberty.

Most cases of scoliosis are mild and require no treatment. Even if this is the case for your granddaughter, her doctor should examine her regularly to make sure that the curve is not getting worse. Her doctor may also advise her to avoid heavy contact sports or gymnastics.

More severe cases that cause discomfort or other symptoms often require treatment. So do mild cases that are likely to get worse. Treatment may include back-strengthening exercises. For the worst cases, a doctor may recommend a special back brace or even surgery. Braces and surgery can stop the condition from worsening, and they can often help straighten the spine, though not completely.

Severe and untreated scoliosis can cause back pain, permanent deformities, and breathing or heart problems. Fortunately, this is rare, and treatments available today typically stop the condition from becoming severe.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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