As Families Defer Pediatric Doctor Visits, Scoliosis Diagnoses May be Missed

Rolando F. Roberto, M.D., author of this article, is an orthopaedic spine surgeon at Shriners Hospitals for Children — Northern California. Board certified by the American Board of Orthopaedic Surgery, he has presented and published extensively in the areas of spinal deformity, spinal trauma and cervical disorders, and recently on the prevention of spinal infections in elective spinal surgery. The recipient of many research grants, he has participated in numerous medical research studies.

Dr. Roberto is an associate clinical professor of orthopaedic surgery and the orthopaedic residency program director at UC Davis School of Medicine, where he has been a professor since 2003. He is the recipient of two outstanding faculty awards from the department of orthopaedic surgery at UC Davis School of Medicine. Dr. Roberto’s professional affiliations include the Scoliosis Research Society, North American Spine Society and J. Robert Gladden Orthopaedic Society. He previously taught at The University of Arizona College of Medicine - Tucson, in the departments of orthopaedic surgery, where he also received two outstanding faculty awards.

The COVID-19 pandemic has caused a dramatic reduction in routine preventive health care. With fewer doctor visits, more conditions are going undiagnosed and untreated.

According to a recent American Academy of Pediatrics survey, the pandemic has caused a dramatic reduction in pediatrician visits. Two-thirds of primary care pediatricians have reported practice visits are down.^[1]

As a physician, I am concerned about how the reduction in preventative care today will affect the state of our public’s health tomorrow. As an orthopaedic spine specialist, I am especially concerned about how the current pandemic will affect preteens who are in the early stages of developing adolescent-onset scoliosis.

Scoliosis is a sideways curvature of the spine, and affects 2-3% of the population – an estimated six to nine million people in the United States.^[2] The most common type is adolescent idiopathic scoliosis and usually appears first in children between 10 and 12 years old, during the growth spurt just before puberty.

I want to stress that the first signs of adolescent scoliosis are often easy to miss. Between ages 10 and 12, children start to become more private about their bodies. Parents are no longer participating in bathing or dressing routines, which allows for early-stage scoliosis curves to go unnoticed. If left untreated, curves worsen over time. A typical rate of progression is one degree per month during a child’s adolescent growth spurt. The fastest rate of progression is seen in the growth stage that occurs just before the start of puberty.^[3]

Scoliosis is often first identified by school nurses – in states that fund school-based scoliosis screening programs – as well as athletic coaches, or physical education teachers who inform parents. Scoliosis is diagnosed most often during routine pediatric visits, which have declined. With kids participating in distance learning and not participating in organized sports, parents should be looking for the early signs of scoliosis themselves.

First signs of adolescent idiopathic scoliosis in fast growing preteens and teenagers include:

• uneven shoulders
• one shoulder blade protruding more than the other
• ribs that are more prominent on one side
• uneven waistline and/or difference in hip height

I encourage parents to increase their awareness and regularly check for these indicators. If parents spot signs of scoliosis, I urge them to perform a simple spine check on their children at home using the Shriners Hospitals' SpineScreen app. If there are irregularities, schedule an appointment with your pediatrician right away. Although they aren’t readily available, regular pediatrician visits are the best way to screen your child for scoliosis.

Scoliosis diagnosed before a curve progresses beyond a certain point can be treated with abdominal bracing. Bracing helps the developing spine grow straight, and reduces the likelihood of needing spine surgery. While scoliosis surgery is a well-established, safe and effective way to correct certain cases, we always prefer to correct curves with non-surgical bracing whenever possible.

During the pandemic, I encourage parents to be scoliosis-aware. Children grow fast and undiagnosed scoliosis will progress very quickly. It’s important to build checking your child’s spine into your parenting routine. And when COVID-19 subsides, remember to schedule frequent visits with your pediatrician to assure good spine health.

^[1] https://www.aappublications.org/news/2020/11/18/pandemicimpact111820

^[2] https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis

^[3] https://www.chla.org/adolescent-idiopathic-scoliosis