Scoliosis

儿童和青少年脊柱侧弯的症状是什么？

Because the spine can curve in many different ways, the脊柱侧弯的症状在不同的孩子中有所不同。脊柱侧弯的常见体征和症状包括：

• uneven shoulder heights
• 头部不集中在身体的其余部分上
• uneven shoulder blade heights or positions
• 一个肩blade骨比另一个更突出
• 一只手臂比另一只手臂直立
• 臀部高度或位置不平
• 向前弯曲时背部的外观不平衡

Most of the time, scoliosis does not cause back pain or other health problems.

What causes scoliosis in kids and teens?

Different types of scoliosis have different causes.

特发性脊柱侧弯has no known cause but tends to run in families.

Congenital scoliosis当脊柱中的某些椎骨没有完全或不能正确分离时，在怀孕的早期阶段发展。在某些情况下，这是由于这两个问题的结合而引起的。

Neuromuscular scoliosisis a common side effect of conditions such as脑瘫,spina bifida, ormuscular dystrophy。Children with these conditions often have underdeveloped muscles. Because of this, their spines can develop side-to-side curvatures, especially during growth spurts. Syndromes that affect muscular development around the spine, such asMarfan syndromeandDown syndrome， 能够导致syndromic scoliosisin a similar manner.

儿童和青少年脊柱侧弯的其他原因

• 异常骨形成
• connective tissue disorders that cause abnormal tissues and ligaments such asEhlers-Danlos综合征
• 不同的腿长: mild differences in leg lengths may cause a slight curvature but rarely cause a serious curvature
• 脊髓损伤
• infection
• 脊柱肿瘤

Scoliosis is不是是由姿势不佳或背包造成的。

脊柱侧弯是如何诊断出的？

Scoliosis可能很难诊断。一些脊柱曲线可见且明显，但在其他情况下，脊柱曲线却不是。脊柱的曲率通常缓慢进展，不会引起背部疼痛。

Scoliosis is often overlooked until early puberty when adolescents start growing rapidly. Because early diagnosis is an important part of successful treatment, pediatricians, family physicians, and some school programs regularly check children and pre-teens for signs of scoliosis.

The亚当斯前弯曲测试is a common method used to diagnose scoliosis. The patient puts their hands together and bends forward with straight knees, which makes their spine visible through their skin. The clinician looks for unevenness in the hips, ribs, or shoulders. If they see a curve, they may use a scoliometer, a flat piece of metal about the size of an index card, to measure the degree of the curve. A curve of more than five to seven degrees on the scoliometer may indicate scoliosis.

确定曲率程度

If your child has scoliosis, their doctor will gather further information about their spine by asking questions about any family history of scoliosis, doing a physical examination, and looking at anX射线of your child’s spine. This will help the doctor determine:

• 曲线的形状：无论是“ S”还是“ C”形状，以及肋骨和肌肉是否涉及
• the direction of the curve: whether the spine curves to the left, right, or both
• the location of the curve: whether the curve is in the upper or lower spine, or both
• 曲线的程度：曲线是轻度，中度还是重度

How is adolescent scoliosis treated?

在青少年和青少年中脊柱侧弯的治疗取决于脊柱侧弯，发育阶段和曲线严重程度的类型。在大多数情况下，脊柱侧弯无需手术就可以治疗。您的孩子的医生将根据他们从X射线和身体检查中学到的知识来确定治疗计划和随访。

非手术性脊柱侧弯治疗

Observation and monitoring

Children with a mild curve, less than 25 degrees, are typically monitored at regular doctor visits to be sure the curve does not get worse. In young children, mild curves of the spine have the potential to become worse as the child grows and develops. In older teens who have reached their mature height, mild curves may not be a problem.

Monitoring is particularly important during growth spurts, which typically take place in girls between the ages of 10 and 14 and in boys between the ages of 12 and 16.

Physical therapy

物理治疗的目标是最大限度地提高您的child’s physical function so scoliosis will not prevent them from leading an active life. A physical therapist will teach your child exercises that can address pain and imbalance. Physical therapy requires a commitment on your child’s part to do the exercise as prescribed, often for up to an hour or more a day.

Schroth疗法结合了呼吸运动和身体运动。它有时与脊柱侧弯患者的其他形式的物理疗法结合使用。

Bracing

If your growing child’s curve is between 25 and 45 degrees, or if it is getting worse, their physician may recommend支撑。A scoliosis brace will be specifically designed for your child and their particular curve. Thebraceholds your child’s spine in a straighter position while they’re growing to partly correct the curve or prevent it from increasing.

Casting

In certain situations, doctors recommend a cast. A cast serves a similar purpose as a brace; it prevents an abnormal spinal curve from becoming worse as the child grows. Casts are typically changed every two to three months, depending on the child’s age.

Treatment with surgery

尽管每个人都尽了最大的努力，但有些曲线对支撑没有反应，也不会太严重，无法用支撑治疗。在这种情况下，这些患者将需要手术。在可能的情况下，外科医生将手术推迟到儿童成长突破之后。

脊柱融合

脊柱融合surgery是青少年严重脊柱侧弯的最常见手术治疗方法。使用金属棒，钩子，螺钉和电线（称为仪表），该过程将脊柱拉直并固化骨骼以防止进一步的异常弯曲。手术后六到12个月，脊柱与骨折愈合的方式融合几乎相同。在这段时间里，孩子可能需要戴上支撑。仪器通常保留在后背而不会引起任何问题。

Treatment for toddlers with scoliosis

Scoliosis treatment is different for very young children whose spines are at an earlier state of growth. Options for early-onset scoliosis include:

• Casting可以用代替为那些不愿戴上支撑而奋斗的幼儿。在孩子处于麻醉状态的同时，需要每两到三个月更换一次演员。
• Bracinghas become an option for infants and very young children thanks to an innovative collaboration between Boston Children’s and波士顿矫正和假肢。
• 生长杆are temporary implants that control spinal curvature as a child grows. The rods are attached to the spine with screws. About every six months, a surgeon lengthens the rods through a small incision in the back to allow the child’s spine to continue growing.
• TheMAGEC（磁扩展控制）系统is an adjustable growing rod system that uses magnetic technology to lengthen the rods without surgery. After an initial operation to implant the MAGEC system, the surgeon periodically lengthens the rods using a remote control.
• Expansion thoracostomy/VEPTR™is an expandable titanium rib used for children with underdeveloped chests. By keeping the chest wall expanded, the VEPTR creates room for the lungs to develop and the spine to grow straight instead of curved.

How we care for scoliosis in kids and teens

TheSpine Division在波士欧宝彩票平台顿儿童医院是美国最大，最繁忙的儿科脊柱中心。我们的脊柱专家看到数千名脊柱患者，每年进行数百次脊柱手术。我们将所有类型的脊柱侧弯和其他脊柱疾病处理，从最常见的是最复杂的。

With early intervention, the majority of our patients are treated successfully with支撑and other non-invasive treatments such as physical therapy and Schroth therapy. The most widely used brace for scoliosis, the波士顿布雷斯，在40多年前在波士顿儿童开发。今天，我们继续不懈地努力进一步改善脊柱侧弯和其他脊柱疾病的非手术治疗方法。

For children who need surgery, our surgical team includes surgeons, anesthesiologists, and nurses with specific skills and expertise inspinal fusion surgery。Each member of the team plays a role in ensuringquality and safetybefore, during, and after surgery.

What is the long-term outlook for children with scoliosis?

Most children and teens diagnosed with scoliosis can look forward to normal, active lives. Your child’s outlook depends in large part on the nature and severity of their scoliosis. Age also plays an important role. Early diagnosis and treatment can improve the outlook for many children with scoliosis.

Patient and family guide to scoliosis

这本针对患者和家庭的电子书分享了有关脊柱侧弯的诊断和管理的信息，并提供有关如何患病的建议。

Embrace the brace digital slideshow

Patients and providers offer advice to help others with scoliosis thrive while wearing a brace.

如何支持必须戴上支撑的孩子

Experts at Boston Children’s answer questions about what it’s like to wear a brace and how a parent can support their child when they have to wear one.