Everything you need to know about scoliosis

Scoliosis causes one side of the spine to curve. It may affect any part of the spine but the most common regions are at chest level and lower back level.

It often shows up in kids. Treatment is not necessary in most cases, since the curve corrects itself with development. However, a combination of bracing and physical therapy is often recommended, based on the degree of curvature and the child’s age.

A very small number of scoliosis patients could need surgery. Scoliosis risks include chronic pain, shortness of breath and decreased exercise ability.

Important facts about scoliosis

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 also have a C- or S-shaped curve in their spine.

It may manifest at any age, but it mostly occurs from 10 to 12 years of age or during adolescents, although symptoms may occur in infants.

The reasons for the shape change are usually not known, but some cases are associated with cerebral palsy, muscular dystrophy, spina bifida, or a birth defect.

A structural curve is permanent, and could be due to a different condition. A non-structural curve is temporary, and will therefore vanish over time.

Treatment

Most children with scoliosis have a mild curve that requires no treatment.

The doctor will prescribe testing of the spine curve in clinic and regularly with X-rays every 4 to 6 months.

When deciding on treatment options the doctor will consider the following factors:

  • 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

Casting is often used for infantile scoliosis instead of bracing to help the child’s spine return to its natural position as it develops. This can be done using a cast made out of Paris plaster.

The cast is fixed to the outside of the patient’s body and will always be worn. The cast is changed regularly because the infant is growing rapidly.

Braces

If the patient has moderate scoliosis, and the bones still grow, a brace may be recommended by the doctor. This will prevent any further curvature, but will not reverse or cure it. Braces are usually worn throughout, even at night. The more hours the patient wears the brace a day, the more it appears to be successful.

The brace typically does not restrict what the child can do. The braces may be taken off if the child decides to take part in physical activity.

The braces are no longer used when bones stop developing. There are 2 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 getting worse or having to undergo surgery.

Chiropractic treatment

Some people visit a chiropractor to reduce the scoliosis pain and discomfort.

Chiropractors manipulate the spine and offer alternative therapies. They believe that reconfiguring the spine would facilitate well-being and healing.

Chiropractic treatment for a person with scoliosis may improve the quality of life. Yet it’s not a cure. While this may help people with scoliosis feel better, it does not resolve the spine curvature.

Visiting a Chiropractor who is specialized in scoliosis is important. Receiving non-specialist chiropractic treatment can make the symptoms worse.

Symptoms

Scoliosis normally becomes apparent from infancy or adolescence.

Symptoms in adolescents

Often, the clothes of people with scoliosis do not hang properly.
Often, the clothes of people with scoliosis do not hang properly.

Appears the most common type of scoliosis in adolescents. It is known as idiopathic scoliosis in adolescents. It can affect children aged 10 years and up.

“Idiopathic” means no known cause. Symptoms can include the:

  • the head is slightly off center
  • the ribcage is not symmetrical, so the ribs may be at different heights
  • one hip is more prominent than the other
  • a person’s clothes do not hang properly
  • one shoulder, or shoulder blade, is higher than the other
  • the person may lean to one side
  • uneven leg lengths

Symptoms in infants

In infants, symptoms can include:

  • a bulge on one side of the chest
  • consistently lying curved to one side (in babies)
  • problems with the heart and lungs, leading to shortness of breath and chest pain (in more severe cases)

Some types of scoliosis can cause back pain but typically it is not very painful. Back pain in older adults with longstanding scoliosis is not uncommon.

If a person is not treated for their scoliosis, complications may occur later in life, such as impaired function of the heart and lungs.

Exercises

Different exercises can help with scoliosis and different schools recommend different approaches. However to achieve the “normal” posture, they all aim to realign the spine, rib cage, shoulders and pelvis.

Some researchers clarified in 2016 that there is growing evidence suggesting that exercise could help treat scoliosis. There is therefore a need for more research to find out which exercises are most successful.

Surgery

Scoliosis can progress over time, in severe cases. For these cases , the doctor can prescribe spinal fusion. This surgery decreases the spine curve and stops it from getting worse.

Scoliosis surgery involves the following:

  • Bone grafts: A surgeon will connect two or more vertebrae with new bone grafts. Sometimes, they will use metal rods, hooks, screws, or wires to hold a part of the spine straight while the bone heals.
  • Intensive care: The operation lasts 4–8 hours. After surgery, the hospital will transfer a child to an intensive care unit (ICU), where they will receive intravenous fluid and pain relief medication. In most cases, the child will leave the ICU within 24 hours, but they may have to remain in the 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, they may need a back brace to support the spine for about 6 months.

They will need to come back to hospital every 6 months to lengthen the rods. Normally this is an outpatient procedure, so that the person is not spending the night. When the spine has grown a surgeon will remove the rods.

A doctor can prescribe spinal fusion only if they believe the benefits outweigh the risks. The danger lies in:

  • 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.

Causes

Scoliosis is sometimes caused by neuromuscular conditions.
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.

Risk factors

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.

Types

The UK Scoliosis Association 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

Diagnosis

A doctor will do a physical exam on the spine, ribs, hips, and shoulders.

The doctor can measure the degree of scoliosis with the aid of a tool called an inclinometer, or scoliometer.

Someone should refer the patient to an orthopedic specialist.

Imaging scans such as X-rays , CT scans, and MRIs can aid in determining curve shape, direction, location, and angle.

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