Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can be moderate to severe. Any part of the spine can be bent in scoliosis; but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis).
According to the National Health Service (NHS), UK, in 80% of cases there is no known cause - it is idiopathic.
The majority of children with scoliosis require no treatment, as the condition resolves on its own as the child grows. Those who do require treatment use a back brace, which is usually effective. A very small number of patients with scoliosis may require surgery. If left untreated, the condition can lead to serious spine, chest, pelvis, heart and lung damage.
Symptoms of scoliosis
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Scoliosis signs and symptoms in children:
The majority of children with scoliosis require no treatment, as the condition resolves on its own as the child grows
- Shoulders may not be of the same height (one is higher than the other)
- Head is not centered directly above the pelvis
- Ribcage is not symmetrical; ribs may be at different heights
- A shoulder blade is higher and more prominent than the other
- One hip is more prominent than the other
- Clothes do not hang properly
- The individual may lean to one side
- Uneven leg lengths
Scoliosis signs and symptoms in babies:
- A bulge on one side of the chest
- The baby might be consistently lying curved to one side
In more severe cases the heart and lungs may not work properly and the patient may experience shortness of breath and chest pain.
Some types of scoliosis can cause back pain.
In the vast majority of cases scoliosis is not painful.
Risk factors for scoliosis
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Age - scoliosis signs and symptoms often start during a growth spurt that occurs just before puberty.
Gender - females have a higher risk of worsening symptoms.
Genetics - people with scoliosis are more likely to have close relatives with the same condition than other people.
Causes of scoliosis
The following are possible causes of scoliosis:
- Idiopathic scoliosis (unknown cause) - in about 80% of cases the cause is unknown.
- Neuromuscular conditions - these are conditions that affect the nerves and muscles. About 20% of scoliosis cases are caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy. In such cases the child may not be able to walk to stay upright, further preventing the spins from growing properly.
- Congenital scoliosis (present at birth) - this is rare and occurs because of the bones in the spine developing abnormally when the fetus is developing in the uterus (womb).
- Genes - The first gene associated with adolescent idiopathic scoliosis was identified by scientists at the RIKEN Center for Integrative Medical Sciences in Japan. The gene - GPR126 - is involved in the growth and development of the spine during the early years of a human's life. Their finding was published in the journal Nature Genetics.
- Leg length - if one leg is longer than the other the individual may develop scoliosis.
- Other causes - bad posture, using backpacks or satchels, and exercise may also cause scoliosis.
Diagnosis of scoliosis
An x-ray of a scoliosis patient
Most commonly the doctor will carry out a physical examination of the spine, ribs, hips and shoulders. In most cases the initial diagnosis is made by a GP (general practitioner) or school nurse, who will then refer the patient to an orthopedic specialist (skeletal system and associated muscles, joints, and ligaments specialist doctor).
Imaging scans - the specialist will order an X-ray to confirm the diagnosis of scoliosis, as well as determining the shape, direction, location and angle of the curve.
If there are further symptoms, such as back pain, or if symptoms are severe an MRI (magnetic resonance imaging) or CT (computed tomography) scan may be ordered.
Bone scan - radioactive material is injected into the bloodstream. This material travels to the parts of the bones that are affected, and show up on a special instrument called a scanner.
On the next page we look at the treatments for scoliosis and possible complications associated with the condition.