Scoliosis in Children: Concerns and Surgical Options

About a young girl's life?

Hello Dr.
Luo, my daughter is 9 years old.
Since birth, her spine has been tilted to the left, resulting in an uneven protrusion of tissue on her buttocks.
We previously took her to an orthopedic specialist who mentioned that she has scoliosis and expressed concern about potential nerve compression and future complications, but did not provide detailed explanations.
I would like to ask Dr.
Luo if the excess tissue can be reshaped and whether it poses any risks, as well as questions regarding the cost.
Additionally, will this condition affect her development? Thank you.

Mama de Tong, 20~29 year old female. Ask Date: 2000/11/16

Dr. Luo Qihua reply Plastic Surgery

Scoliosis causes deformities in the body, primarily due to issues with the bones themselves.
It is quite difficult to correct "extra muscle mass" through cosmetic surgery.
However, scoliosis can sometimes worsen, especially during puberty when the body is growing.
The growth of the spine during this time is a concern, particularly if it affects cardiopulmonary function.
For these issues, it is essential to consult an orthopedic spine (or spinal) surgeon.

Reply Date: 2000/11/16

More Info

Scoliosis in children is a condition characterized by an abnormal lateral curvature of the spine. It can manifest at various ages, and in your daughter's case, it appears to have been present since birth. The concerns surrounding scoliosis often revolve around potential complications, including nerve compression, pain, and cosmetic issues, as well as the impact on growth and development.

Understanding Scoliosis
Scoliosis can be classified into several types, including idiopathic (the most common type, with no known cause), congenital (resulting from vertebral anomalies present at birth), and neuromuscular (associated with conditions like cerebral palsy or muscular dystrophy). In your daughter's case, it seems to be a structural issue that has led to an observable asymmetry in her body, particularly with the prominence of one side of her buttocks.

Concerns and Risks
The primary concerns with scoliosis include:
1. Progression of the Curve: Scoliosis can worsen over time, especially during growth spurts. Regular monitoring is essential to assess whether the curvature is increasing.

2. Neurological Complications: Severe curves can potentially lead to nerve compression, which may cause pain, numbness, or weakness in the legs. This is particularly concerning if the curvature is significant.

3. Respiratory Issues: In severe cases, scoliosis can affect lung function due to reduced space in the thoracic cavity.

4. Cosmetic Concerns: The physical appearance can be affected, leading to self-esteem issues, especially in children as they grow older.

Surgical Options
Surgical intervention for scoliosis is typically considered when the curvature exceeds 40-50 degrees and is progressive, or if there are significant symptoms. The most common surgical procedure is spinal fusion, where the curved vertebrae are fused together to correct the alignment and prevent further curvature.
However, surgery is not without risks, including infection, blood loss, and complications related to anesthesia. The decision to proceed with surgery should involve a thorough discussion with a pediatric orthopedic surgeon who specializes in spinal deformities.

Non-Surgical Options
Before considering surgery, there are non-surgical options that may be explored:
1. Observation: Regular check-ups to monitor the curvature, especially if it is mild and not causing symptoms.

2. Bracing: In some cases, especially in growing children, a brace may be recommended to prevent further curvature. This is typically more effective in younger children whose bones are still growing.

3. Physical Therapy: While it may not correct the curvature, physical therapy can help strengthen the muscles around the spine and improve posture.

Cosmetic Concerns
Regarding the additional prominence on one side of her buttocks, this is likely due to the muscle imbalance caused by the scoliosis. Surgical options for cosmetic correction, such as liposuction or other body contouring procedures, should be approached with caution, especially in a child. It is crucial to consult with a pediatric plastic surgeon who can assess the situation and provide guidance on the safety and appropriateness of such procedures.

Conclusion
In summary, it is essential to have a comprehensive evaluation by a pediatric orthopedic specialist who can assess the degree of curvature, monitor for any progression, and discuss the best course of action. Regular follow-ups are crucial to ensure that any changes in her condition are addressed promptly. The decision regarding surgery or cosmetic procedures should be made with careful consideration of the risks and benefits, as well as the potential impact on your daughter's overall development and quality of life.

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