As time goes on (whether or not the muscle weakness progresses) and as the scoliosis increases, there is progressive tilting of the pelvis (pelvic obliquity). This causes increasing difficulty in sitting, as your child’s weight is no longer distributed evenly between the buttocks. Scoliosis may then make sitting less comfortable for your child. Scoliosis can often alter the shape of the chest and restrict the capacity of the lungs and so breathing can become less efficient. Scoliosis may cause your child to have to use their arms to support their body through the armrests of his/her chair.
What can be done?
The following are some management approaches that may be offered to slow down the progression of the scoliosis in your child:
- Standing and walking have a protective effect on the development of scoliosis. It will benefit children who are able to walk (supported or unsupported) to keep mobile and encourage symmetrical supported standing (for example with standing frames) in those who can stand for as long as possible.
- In some muscular dystrophies steroid medication is used to help prolong walking. There is increasing evidence that steroid medication in DMD may reduce the development of scoliosis and even the need for surgery.
- Those children who walk well but who have an increasing scoliosis (an uncommon situation) may benefit from wearing a plastic spinal support called a brace. For those who have significant difficulties in walking, a brace may make it more so. An operation may then be the best solution.
- For young children who are unable to walk, a spinal brace may be recommended to delay the progress of scoliosis until most of the growth of the spine is completed and allow optimal sitting position of your child. This decision is based upon scoliosis X-rays taken when the child is sitting. However a brace is unlikely to completely prevent such a curve from progressing.
- A brace may be the management of choice if your child develops a scoliosis late, commonly after the age of 14 years, if the curvature remains mild and does not deteriorate.
- If your child is sufficiently well grown, or if the curve is progressing quickly or the breathing or heart function deteriorates an operation to correct the scoliosis and stabilise the spine is likely to be the treatment of choice.
- Modified seating arrangements for their electric wheelchairs might be an alternative solution for those children who are overweight or where surgery is declined or not an option in view of severe respiratory or cardiac problems.