Childhood Orthopaedic Problems: Scoliosis

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Guest:  Dr. Jennifer Hooker – Pediatric Orthopedic Surgery

Host:  Dr. Linda Austin – Psychiatry

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Jenny Hooker who is Assistant Professor of Pediatric Orthopedics here at the Children’s Hospital of MUSC.  Dr. Hooker, let’s talk about a problem that is, I suppose, a fairly common problem in the work that you do, scoliosis.  Just what is scoliosis?

Dr. Jenny Hooker:  Scoliosis, actually, is more difficult to define than you might think.  A lot of patients get referred to us and they say, “Doctor, I was told my back is crooked so, I have scoliosis.”  Scoliosis is actually an x-ray, or a radiologic, diagnosis that we base on how much curve we can measure on your x-ray.  So, it’s a side-to-side, or lateral bend, in the bones of the spine that we measure on the basis of an x-ray.  

Dr. Linda Austin:  Would it be fair to say that, as you’re looking at the back, if you had x-ray vision, would it be a sort of C-curve or an S-curve in the spine? 

Dr. Jenny Hooker:  Actually, both of those are correct.  You can see either a C curve or an S curve, depending on the curve pattern.  What we typically see when we look at patients is actually what usually what makes them present to us.  And that finding is that one of the shoulders will often be higher than the other one, or patients may notice that they’re waistline is asymmetric.  Or, they may actually notice that their shoulder is more prominent in the back, that they have what we kind of, colloquially, refer to as a rib hump.

Dr. Linda Austin:  At what age does this tend to show up?

Dr. Jenny Hooker:  The most common age of presentation is in the early adolescent years, between the ages of 11-14 or so.  There are other forms of scoliosis which we would call, congenital, meaning that they’re there from birth, which can present much earlier.  And there are also some juvenile forms which can present in the three to five-year age range.  

Dr. Linda Austin:  Then, it sounds as if, oftentimes, it may look as if the spine is very straight until the child really starts growing in puberty.  Is that right?  And then that’s when the curve emerges?

Dr. Jenny Hooker:  That’s exactly right, yes.  The time that we tend to see scoliosis present is the time when the curve is actually progressing, or enlarging.  Typically that happens when people are growing at their fastest rate.  And, as you’ve watched children around you, of course, you know that children go through growth spurts primarily in their early adolescence, and tha

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