Spinal asymmetry or juvenile scoliosis?

These past few months have been a roller-coaster ride. For about two years my daughter has been periodically complaining about having a sore back. At first I ignored her complaints. After-all, I have pain in my back on-and-off too, so do most people I know. I figured that minor back pain just a part of being in the 'vertebrate' family of species. But as she continued to complain it occurred to me that it may not be normal for a 5-6 year old to complain so frequently about back pain. So we (her father and I) decided to take Chloe to the doctor just incase this is something more serious.

Our family doctor did the standard forward bend test (Adam's test) to check for a curve in her spine. He checked her shoulders, to see if they were even. He also checked her hips to see if they were level. And when she bent forward, he checked her back to see if there was any visible asymmetry. He didn't see any substantial unbalance in her shoulders or hips, but we all could see a slight curve in her back toward the right. And, when we looked more closely, we could see an slight elevation of the right side of her back caused by the rotation of her trunk-what some call a rib hump. (Note: Angle of trunk rotation is also referred to as ATR)

We were given a requisition to go to the Children's Hospital in Eastern Ontario (CHEO) for x-rays.  In December 2010 Chloe's x-rays were taken and a week later we received the results. The report on Chloe's x-ray claimed that she had an 18 degree curve in her back and referred us to the orthopedic surgeon.

In an effort to get the best information possible about Chloe, we decided to make an appointment with a second orthopedic surgeon who was referred to us through a friend's physiotherapist. The appointment took place last week on April 9, 2010. The hospital took two x-rays with their EOS III machine, which is a low-dose 3D imaging device. In case you didn't know, x-ray exposure increases the risk of developing cancer--so if you can avoid taking x-rays you should. We are trying to keep Chloe's x-ray exposure down to a minimum. The EOS III machine decreases radiation exposure by 100-500 times (compared to typical scanners).

Once the x-rays were ready we met with the orthopedic surgeon. He analyzed the x-rays and examined Chloe using the forward bend test and a scoliometer. His reading of the x-rays determined that she had a 16 degree curve in her spine and the scoliometer reading showed a significant enough ATR to warrant concern. In his opinion Chloe has juvenile scoliosis and needs to be fitted with a brace immediately. If she does not receive treatment the curve will worsen and there will be 100% chance that she'll need surgery. And, surgery is something to be avoided if at all possible because there are several possible complications and negative long-term effects.

What a shock to hear all of this! I was expecting to hear that Chloe's curve was small and not anything to be concerned about. I was expecting to hear that her curve would either stay as it is or straighten itself out with time. Not in a million years did I expect to receive such alarming information. Trying to come to terms with the fact that Chloe had juvenile scoliosis. That, without treatment there would probably be 100% chance that down the road she would have to have spinal surgery (which could have devastating results). She would have to be fitted with a brace immediately and wear it 20 hours per day for the next 8 years of her life--only to decrease the chances of her requiring surgery down the road to 30%. Imagine going through all of that and still requiring surgery down the road!

Yesterday, we met with the second orthopedic surgeon and received a completely different diagnosis. He examined the original x-rays taken at CHEO and did not agree with the report (where they found the angle to be 18 degrees). He measured the angles several times and determined that there was a less then 10 degree curve. He even tried to exaggerate the results and was only able to get 13% curve. He also examined Chloe using a number of physical exams, including the forward bend test with a scoliometer where he reported only mild asymmetry with a 4 degree ATR. His diagnosis was that Chloe did not have juvenile scoliosis, but rather spinal asymmetry. And, spinal asymmetry does not require a brace and could potentially remain the same or even correct itself. Wow - what a different opinion! I was thoroughly confused.

He went on to say that there is a chance that Chloe does actually have juvenile scoliosis, so we should watch her very closely for any signs of progression in the curve. If the curve in her back does progress, we will need to reexamine her back and take it from there.

It amazes me how drastically different these two prognosis' are. And now, I feel like I need a third unbiased opinion. Fortunately I have a friend who's brother is an orthopedic surgeon so maybe he'll be able to shed some light into the situation. Right now, I'm leaning toward the watch-and-wait recommendation. It's less invasive for my six year old daughter. Four months down the road, if there is any change in the curve of her spine we'll evaluate once again whether it could be juvenile scoliosis.

I'd love to hear anyone's stories about spinal abnormalities, asymmetry, scoliosis, etc.