Featured pediatric expert
Afshin Aminian, MD
An internationally-recognized and sought-after expert in pediatric orthopedics, Dr. Afshin Aminian has presented at numerous conferences and meetings in the United States and abroad. He has presented several times at the International Meeting on Advanced Spine Techniques. He gave a presentation on the influence of surgical correction on thoracic hypokyphosis on sagittal spinal pelvic parameters in AIS, a second presentation on the correction of AIS via posterior medial derotational maneuver, and a third on thoracic kyphosis and sagittal pelvic parameters in AIS.
Transcription
Maggie McKay (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Rady Children’s Health. I’m Maggie McKay. And here to help us understand pediatric scoliosis is Dr. Afshin Aminian, an orthopedic surgeon and Division Chief of Orthopedic Surgery at the Rady Children’s Health in orange County. Thank you so much for joining us, Dr. Aminian.
Afshin Aminian, MD: My pleasure, Maggie. Thank you for having me.
Host: Absolutely. So, let’s just dive right in. When a parent hears “Your child has scoliosis,” what’s the very first thing you want them to know?
Afshin Aminian, MD: That’s a very good question. Obviously, we live in an era that constantly we Google things, and there’s so many variety of different types in adults and young people and adolescent. And basically, at the end of the day, the word scoliosis means you got a normal spine that had just twisted.
Host: All right. So, a lot of parents blame themselves. “Did I miss something? Did I cause this?” What do you tell them?
Afshin Aminian, MD: Absolutely not. This is a very common thing. We do routine school screening, and that’s what’s recommended by American Academy of Pediatricians and the American Academy of Orthopedic Surgeons. And this is nothing that a parent should be worried about, that they missed it and that it’s something that they caused.
Host: So, walk us through what treatment actually looks like. When do you watch and wait? When does bracing come in? And when is surgery part of the conversation?
Afshin Aminian, MD: Perfect. So as I said, this is a common thing that all the pediatricians screen the kids in middle school. Early detection is key. So, you know, the great pediatricians see you every year, so don’t miss those visits. So when you go see your pediatrician, they’ll do the simple test. It takes literally 30 seconds. They lean you forward, and they put this device, which is a leveler called scoliometer, on your back. And if there’s asymmetry, they say, “Okay, well, you might have scoliosis.” Again, no big deal. The next step is sometimes you go see an orthopedist or you go get an X-ray.
A lot of times, 99 out of 100 of these cases, these are usually mild forms of curvature or twist. Sometimes even the X-rays come back as mild dexoscoliosis or levoscoliosis, so that means twist to the left or twist to the right. And most of these measurements are under 10 degrees, so we don’t even technically call these scoliosis, even if the X-ray read comes back as there is, you know, mild scoliosis. Again, that’s sort of not a worrisome thing, and a lot of this stuff is sort of benign and could be monitored closely.
But then, the next step is you go see your orthopedic surgeon that specializes in this. Majority of the curves are benign, mild, and they could be observed. Some of the curves that are on X-ray measurements are more than 20 degrees, then certainly there’s some options that we could discuss with therapy, optimization of, you know, calcium, vitamin D, and then bracing program, as you just brought up.
So, we have a very good non-operative treatment that we start early with good results. So, not necessarily this is sort of a worrisome thing, especially at the earlier stages. Rarely, you could have patients coming in late, and again, when they present late with severe deformity, then that’s again something that could be fixed, obviously surgical, which you don’t like to hear the first visit, but that’s rare, because usually we catch them at earlier stages.
But, you know, we tell the kids that even if you have a severe case, this is not a devastating condition. This is not like you’re sick. You know, you could go out there, have fun, do everything. It just means your spine is twisted and crooked. And just like, you know, you have crooked teeth, you’re going to go get it straightened, don’t worry, the doctor could straighten you, and you’ll be perfectly fine.
Host: So if you could give every newly diagnosed family three questions to bring to their next appointment, what would they be quickly?
Afshin Aminian, MD: I would say, “Is there any activity limitations for my child? Is my child’s health negatively affected by this physiologically?” And in the worst case scenario, “Is this something that could be treated?”
Host: How do parents talk to their child about this diagnosis? Because that’s got to be a tough one. Does that conversation change depending on their age, like if they’re seven or if they’re a teenager?
Afshin Aminian, MD: Absolutely. So, we live in the era of social media. And scoliosis affects kids in middle school, more prevalent in girls than boys. And we know from all the studies, you know, girls around eleven, twelve, thirteen are most vulnerable, especially body image, self-esteem. At the earlier stages, this is something, again, it’s really mild. But obviously, it might not be mild to some children.
So, I think you should create a very safe environment, that the child should feel comfortable discussing if they have body image or self-esteem issues due to their, you know, appearance. And that’s something we care about. We’re not going to, you know, ignore the child. We could discuss it and educate them. And once they learn what’s going on and they understand why the body looks a little bit asymmetrical, I think they’ll be more understanding.
Host: What does life actually look like for these kids? Like sports, activities, adulthood. What’s the realistic future a parent can hold on to?
Afshin Aminian, MD: So, majority, again, are mild, and you just observe. They might have to have a period of bracing as they’re going through adolescent growth, but they are able to participate in all sports, contact sports. They could play flag football. They could do dance, gymnastics. Again, this is nothing that’s going to adversely affect their physiologic well-being. In fact, we tell them the more active they are, the better it is as far as things go with their spine. Again, a very small subset become progressive, and the deformity gets severe. Obviously, when the spine is getting bent or twisted a lot, that’s something that you probably want to have it fixed.
And, you know, in those worst case scenarios, there’s a good option, and we fix them. And the child, even after surgery, could able to, you know, do most of their activities and do perfectly fine. So, majority do fine, nothing to worry about, and the small subset that get worse, they could be treated, and they should be fine.
Host: Well, that’s a seems very encouraging. What do you wish every parent or child knew about the diagnosis that would make them less afraid?
Afshin Aminian, MD: It’s an old diagnosis. It’s been around for thousands of years. The child is fine. They could do whatever activities. There might be a little bit of a nuisance with bracing while they’re going through adolescence and, you know, that’s not new. You know, we do it for our teeth all the time. So, I tell the kids, “You can still chew and, you know, swallow, but you got to get your teeth fixed. Because you want to get you want to have not have any troubles.” So, it’s kind of the similar thing.
And in the worst-case scenario, if that becomes problematic, you live in an era that we can fix it. Parents shouldn’t worry, like, “Hey, you know, if you’re in that very small subset that might end up with progression of the curve and deformity, then that could be fixed, and your child’s going to be fine.
Host: Well, this has been so informative and reassuring and encouraging. Thank you for sharing your expertise today. We really appreciate it.
Afshin Aminian, MD: Of course. My pleasure.
Host: Again, that’s Dr. Afshin Aminian. To find out more, please visit choc.org/orthopedics. And thank you for tuning in to Long Live Childhood, a pediatric health and wellness podcast brought to you by Rady Children’s Health. For more insightful conversations about kids’ health and wellbeing, be sure to subscribe wherever you listen to your podcasts. Together, we can help keep kids happy, healthy, and thriving. If you enjoyed today’s episode, please consider downloading, subscribing, rating, and reviewing Long Live Childhood on Apple Podcasts, iHeartRadio, Spotify, or Pandora. Your support truly means a lot. Thank you so much for joining us today. Until next time
