The majority of children with scoliosis do not require treatment as the curve corrects itself as the child grows. However, based on the degree of curvature and the age of the child, a combination of bracing and physical therapy is often recommended.
A very small number of patients with scoliosis may require surgery. Complications of scoliosis include chronic pain, respiratory deficiencies, and decreased exercise capacity.
Fast facts on scoliosis
Here are some key points about scoliosis. More detail and supporting information is in the main article.
- often, the causes of scoliosis are not known
- only a small number of scoliosis patients require surgery
- symptoms in babies include a bulge on one side of the chest
- scoliosis affects females more often than males
Scoliosis symptoms in adolescents
Often, the clothes of patients with scoliosis do not hang properly.
Adolescent idiopathic scoliosis is the most common form of scoliosis, and affects children who are at least 10 years old. Idiopathic means that there is no known cause. Symptoms can include:
- the head is slightly off center
- the ribcage is not symmetrical - the ribs may be at different heights
- one hip is more prominent than the other
- clothes do not hang properly
- one shoulder, or shoulder blade, is higher than the other
- the individual may lean to one side
- uneven leg lengths
Scoliosis symptoms in infants
Symptoms can include:
- a bulge on one side of the chest
- the baby might consistently lie 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 but, for the majority of individuals, scoliosis is not overtly painful. Back pain is not uncommon in the older adult population with long-standing scoliosis.
If scoliosis is left untreated (which is rare in the developed world) problems can arise later in life, such as impaired heart and lung function.
Scoliosis risk factors
The risk factors for scoliosis include:
- Age - scoliosis signs and symptoms often start during a growth spurt that occurs just before puberty.
- Gender - females have a higher risk.
- Genetics - people with scoliosis are more likely to have close relatives with the same condition than people without scoliosis.
Scoliosis treatment options
The majority of children with scoliosis have mild curves and don't need treatment. In such cases, the doctor will recommend regular follow-ups every 4-6 months to monitor the curve of the spine in clinic and periodically with X-rays.
The following factors will be considered by the doctor when deciding on treatment options:
- Sex - females are more likely than males to have scoliosis that gradually gets worse.
- Severity of the curve - the larger the curve, the greater the risk of it worsening over time. S-shaped curves, also called "double curves," tend to get worse over time. C-shaped curves are less likely to worsen.
- Curve position - if a curve is located in the center part of the spine, it is more likely to get worse compared with curves in the lower or upper section.
- Bone maturity - the risk of the curve worsening is much lower if the patient's bones have stopped growing. Braces are more effective while bones are still growing.
Casting instead of bracing is sometimes used for infantile scoliosis to help the infant's spine to go back to its normal position as it grows. This can be done with a cast made of plaster of Paris.
The cast is attached to the outside of the patient's body and will be worn at all times. Because the infant is growing rapidly, the cast is changed regularly.
If the patient has moderate scoliosis and the bones are still growing, the doctor may recommend a brace. This will prevent further curvature, but will not cure or reverse it. Braces are usually worn all the time, even at night. The more hours per day the patient wears the brace, the more effective it tends to be.
The brace does not normally restrict what the child can do. If the child wishes to take part in physical activity, the braces can be taken off.
When the bones stop growing, braces are no longer used. There are two types of braces:
- Thoracolumbosacral orthosis (TLSO) - the TLSO is made of plastic and designed to fit neatly around the body's curves. It is not usually visible under clothing.
- Milwaukee brace - this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.
One study found that when bracing is used on 10-15 year olds with idiopathic scoliosis, it reduces the risk of the condition getting worse or needing surgery.
Scoliosis surgery (spinal fusion)
In severe cases, scoliosis can progress over time. In these cases, the physician may recommend spinal fusion. This surgery reduces the curve of the spine and stops it from getting worse.
Scoliosis surgery involves the following:
The patient will need to return to the hospital every 6 months to have the rods lengthened - this is usually an outpatient procedure, so the patient does not spend the night. The rods will be surgically removed when the spine has grown.
A doctor will only recommend spinal fusion if the benefits are thought to outweigh the risks. The risks include:
- Rod displacement - a rod may move from its correct position. Although not uncomfortable, the patient may need further surgery.
- Pseudarthrosis - one of the bones used to fuse the spine into place does not stick properly. Some patients may experience mild discomfort, and the spine will not be corrected as successfully. Further surgery may be needed.
- Infection - this is usually treated with antibiotics medication.
- Nerve damage - damage occurs to the nerves of the spine. Results can range from mild, with numbness in one or both legs, to paraplegia (loss of all lower bodily functions). A neurosurgeon may be present for scoliosis surgery.
Scoliosis is sometimes caused by neuromuscular conditions.
Below are some of the possible causes of scoliosis:
- Neuromuscular conditions - these affect the nerves and muscles and include cerebral palsy, poliomyelitis, and muscular dystrophy.
- Congenital scoliosis (present at birth) - this is rare and occurs because the bones in the spine developed abnormally when the fetus was growing inside the mother.
- Specific genes - at least one gene is thought to be involved in scoliosis.
- Leg length - if one leg is longer than the other, the individual may develop scoliosis.
- Syndromic scoliosis - scoliosis can develop as part of another disease, including neurofibromatosis and Marfan's syndrome.
- Osteoporosis - can cause secondary scoliosis due to bone degeneration.
- Other causes - bad posture, carrying backpacks or satchels, connective tissue disorders, and some injuries.
A doctor will carry out a physical examination of the spine, ribs, hips, and shoulders. The doctor can, with the aid of a tool called an inclinometer (Scoliometer), measure the degree of scoliosis. If necessary, the patient will then be referred to an orthopaedic spine specialist or pediatric orthopaedist, if it is a child, who deals specifically with scoliosis.
Diagnosis typically involves the following:
- X-rays - the pediatrician or orthopedic surgeon will order an X-ray to evaluate for scoliosis, as well as determining the shape, direction, location, and angle of the curve.
- Imaging scans - If there are further symptoms, such as back pain, or if symptoms are severe, an MRI or CT scan may be ordered.
Scoliosis should not be confused with lordosis - where the spine curves inward at the lower spine, and kyphosis -where the spine curves is curved forward in the upper back.