Scoliosis

What is scoliosis?

Scoliosis is a condition which causes curvature of the spine. In most cases the spine become either C-shaped or S-shaped and bends either to the left or right. The cause is often unknown and this is termed idiopathic scoliosis.

In a number of cases no treatment may be required, but if the spine is severely curved treatment can be recommended.

Who develops scoliosis?

Scoliosis used to be considered a condition that affected children, but in recent years the number of older adults affected by scoliosis has increased significantly, which is largely due to the ageing population in the UK. In the UK between 0.3 and 0.4 percent of children are affected by scoliosis and symptoms can develop at any age during childhood and adolescence. Girls are most likely to be affected in comparison to boys.

It is estimated that up to 70 percent of people aged over 65 in the UK have a degree of scoliosis, and many cases in older adults may result from the condition not being diagnosed during childhood.

Scoliosis can be inherited through families and anyone with a close relative with the condition is advised to undergo regular checks.

What are the causes of scoliosis?

In the majority of cases (around 8 out of 10 cases) scoliosis is idiopathic, which means that it has an unknown cause. Doctors classify scoliosis according to the type of curve, as follows:

• Non-structural: this means that the structure of the spine is sound and the curve is only temporary. If this is the case doctors will carry out tests to try and determine the cause of the curve.
• Structural: this means that the spine has a structural curve which may be caused by infection, disease, a birth defect or trauma.

Conditions that may cause scoliosis include:

• Neuromuscular conditions, such as cerebral palsy and muscular dystrophy.
• Osteoporosis.
• Conditions that damage the nerves close to the spine, such as Parkinson's disease, motor neurone disease and multiple sclerosis.

In rare cases scoliosis can be present at birth and this is known as congenital scoliosis.

Diagnosing Scoliosis

Doctors will use a combination of examinations and tests to diagnose scoliosis. Firstly, they will take a medical history and ask about your family history, as well as your personal medical record. The doctor will examine your spine to check for signs of curvature and an X-ray will be ordered to confirm a diagnosis. The X-ray shows the shape of the spine and also measures the degree of the curve, as well as identifying the pattern and location of the curve.

Treating Scoliosis

There are different treatment options available for scoliosis and a treatment plan will depend on a number of factors, including:

• The age of the patient.
• The severity of the curve.
• The type or form of scoliosis.
• The development stage of the individual, which is related to how much more the patient is expected to grow.

In some cases doctors may advise examination, but if treatment is required this usually involves surgery or bracing.

Observation: this option involves the doctor carrying out regular checks on the patient's spine (every 4-6 months). This policy is usually adopted for patients with a mild curve (below 25 degrees) and children who have not finished growing.

Bracing: Doctors will recommend bracing in some cases. Bracing involves wearing a brace to help prevent the curve from becoming more severe. Bracing is often recommended in the following cases:

• The patient has not finished growing and there is a curve of higher than 25-30 degrees.
• The patient has not finished growing and there is a curve of between 20 and 29 degrees which seems to be getting worse.
• The patient still has around 2 years of growth left and a curve of between 20 and 29 degrees. In the case of girls this treatment should only be used if she has not yet started her period

Modern braces are designed for comfort and they are very discreet. Some teenagers and children may be worried that they will stand out from their friends because they are wearing a back brace, but modern designs can easily fit underneath a t-shirt. It is important that children are reassured and feel they are able to talk about their condition with others. If your child is struggling with the fact that they have to wear a back brace, reassure them that the treatment will be effective and they will not have to wear it for ever. Some children and teenagers, as well as adults, may benefit from talking to other people in the same situation and there are charities and support groups designed to provide information and support for people with scoliosis.

Surgery: Surgery can be used to improve a curve or prevent a curve from becoming more severe. Surgery is also generally recommended when the curve is severe (over 45 degrees). Surgery usually involves fusing two or more bones together in the spine, and a metal rod or another type of implant may be placed during the procedure to make the spine straighter and more stable.

Exercise and Scoliosis

There is little evidence to suggest that exercise helps to prevent scoliosis getting worse. However, exercise has a range of health benefits and is essential for staying fit and healthy. Exercise helps to improve speed, endurance, strength and flexibility, and it also has benefits for mental health, improving self-esteem and increasing confidence and wellbeing.

Alternate treatments for scoliosis

There have been suggestions that other treatments may be effective for scoliosis. However, there is little evidence to suggest that any of the subsequent treatments are of benefit for patients with scoliosis:

• Chiropractic
• Nutritional supplements
• Electrical stimulation