Everything you need to know about scoliosis
It often appears in children. In most cases, treatment is not needed, as the curve corrects itself with growth. 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.
Here are some key points about scoliosis. More detail is in the main article.
- Often, the causes of scoliosis are not known.
- A few people with scoliosis need surgery.
- Symptoms in infants include a bulge on one side of the chest.
- It is more common in females than in males
What is scoliosis?
A person with scoliosis will have a C- or S-shaped curve in their spine.
It can appear at any age, but it often presents from the age of 10 to 12 years, or during the teens, but infants can sometimres have symptoms.
A structural curve is permanent, and may be due to another condition. A nonstructural curve is temporary and it is likely to diseappear with time.
Most children with scoliosis have a mild curve that does not need treatment.
The doctor will recommend following up every 4 to 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 worsen over time. C-shaped curves are less likely to worsen.
- Curve position: A curve that is is located in the center part of the spine is more likely to get worse compared with curves in the lower or upper section.
- Bone maturity: The risk of worsening is lower if the person'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 normally becomes apparent from infancy or adolescence.
Symptoms in adolescents
Often, the clothes of patients with scoliosis do not hang properly.
The most common form of scoliosis appears in adolescent. It is known as adolescent idiopathic scoliosis. It can affect children from the age of 10 years.
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
Symptoms in infants
In infansts, symptoms can include:
- a bulge on one side of the chest
- the baby might consistently lie curved to one side
- in more severe cases, problems with the heart and lungs, leading to shortness of breath and chest pain
Some types of scoliosis can cause back pain but it is not usually very painful. Back pain is not uncommon in older adults with long-standing scoliosis.
If scoliosis is left untreated, problems can arise later in life, such as impaired heart and lung function.
Various exercises are suggested for scoliosis, and different schools propose different strategies. However, they all aim to realign the spine, rib cage, shoulders, and pelvis, to achieve a "normal" posture.
In 2016, researchers noted that there is growing evidence that exercise can help treat scoliosis, but more work is needed to find out which exercises are the most effective.
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:
- Bone grafts - two or more vertebrae (spine bones) are connected with new bone grafts. Sometimes, metal rods, hooks, screws, or wires are used to hold a part of the spine straight while the bone heals.
- Intensive care - the operation lasts 4-8 hours. After surgery, the child is transferred to an ICU (intensive care unit) where they will be given intravenous fluid and pain relief. In most cases, the child will leave the ICU within 24 hours, but may have to remain in hospital for a week to 10 days.
- Recovery - children can usually go back to school after 4-6 weeks, and can take part in sports roughly 1 year after surgery. In some cases, a back brace is needed to support the spine for about 6 months.
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, so making further surgery necessary.
- Pseudarthrosis: One of the bones used to fuse the spine into place does not stick properly, leading to mild discomfort, and unsuccessful correction of the spine. Further surgery may be needed.
- Infection: If this occurs, it will usually treated with antibiotics.
- Nerve damage: Damage occurs to the nerves of the spine, leading to mild symptoms, such as numbness in one or both legs, to severe problems, such as paraplegia, a loss of all lower body function.
A neurosurgeon may be present during surgery for scoliosis.
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: This can cause secondary scoliosis due to bone degeneration.
- Other causes: Bad posture, carrying backpacks or satchels, connective tissue disorders, and some injuries.
The risk factors for scoliosis include:
- Age: Signs and symptoms often start during a growth spurt just before puberty.
- Gender: Females have a higher risk.
- Genetics: People with scoliosis may have a close relative with the condition.
The Scoliosis Assocition of the United Kingdom describes five main types of scoliosis:
- Congenital scoliosis, when the spine does not form correctly before birth
- Early-onset scoliosis appears between birth and 10 years
- Adolescent idiopathic scoliosis, which occurs as the child grows, leading to a curving and twisting of the spine
- Degenerative scoliosis can affect adults due to wear and tear of the skeletal system, whether or not they already have scoliosis
- Neuromuscular scoliosis stems from a problem with the muscles or nervous system
- Scheuermann's kyphosis, where the front sections of the vertebrae grow more slowly than the back sections, making them smaller
- Syndromic scoliosis is linked to one of a range of syndromes, including Marfan's syndrome and trisomy 21
A doctor will carry out a physical examination of the spine, ribs, hips, and shoulders.
With the aid of a tool called an inclinometer, or scoliometer, the doctor can measure the degree of scoliosis.
The patient may be referred to an orthopedic specialist.
Imaging scans such as x-rays, CT scans and MRIs can help assess the shape, direction, location, and angle of the curve.