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Scoliosis

Scoliosis is a sideways curve of your spine, which may also be rotated (twisted), and has several different causes.

It's normal to have a slight sideways curvature in your spine. Scoliosis is defined as a curve of more than 10 degrees. This curvature of your spine can be C-shape or S-shape, and the spine may also be rotated.

When you’re lifting or standing with a poor posture, it’s normal for your spine to curve. However, scoliosis is a permanent curvature of your spine.

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Idiopathic scoliosis
Scoliosis is a sideways curve to the spine. Idiopathic means that the cause is unknown
An image showing the effects of scoliosis

Details

  • Symptoms Symptoms of scoliosis

    You will usually have no symptoms of scoliosis. However, most people notice a change in the appearance of their back.

    You may notice one shoulder being higher than the other or one shoulder blade sticking out. The space between your body and your arms may look different on each side when you stand with your arms at your side. Your hips may also look uneven. If the curve is in your upper back, your ribs may stick out on one side. This is known as a rib hump.

    If you think you or your child may have scoliosis, see your GP for advice.

  • Diagnosis Diagnosis of scoliosis

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. You may be asked to bend forward from the waist, with the palms of your hands together. One of your shoulders may be higher than the other, your ribs may be more prominent on one side and cause a bulge in your back if you have scoliosis.

    An image showing the scoliosis back bend test

    If your GP thinks you have scoliosis, he or she will usually refer you to a specialist. This is often an orthopaedic specialist (a doctor who specialises in identifying and treating bone conditions).

    Your GP may also refer you to have the following tests.

    • X-rays of your back to show the position and size of the curvature. The curve is given a measurement in degrees, called the Cobb angle. Early X-rays can be compared with later ones to tell whether the curvature is stable or getting more pronounced.
    • CT scan or MRI scan to look at the spinal cord for abnormalities.
  • Treatment Treatment of scoliosis

    Treatment of scoliosis depends on how severe your curve is, whether it‘s likely to get worse and how much it affects your normal function. There are a number of treatment options.

    Observation

    If your scoliosis is mild and not affecting your normal function, your doctor will recommend regular check-ups to monitor the curvature.

    Bracing

    Your doctor may recommend a back brace for children if the curvature is more than around 20 degrees. A brace only works for children who have not finished growing. It will not correct scoliosis, but can help to stop the curvature getting worse. Different types of braces are available, usually made out of a rigid plastic or fibreglass. The most common type covers roughly the same area as a waistcoat. For more marked curvature, a brace that extends higher up the body and under the chin may be required. To be effective, a brace needs to be worn for up to 23 hours a day.

    The medical evidence for how well braces work is mixed, but they're likely to be more effective when treatment is started at a younger age, while the back is still growing. Braces are usually worn until the child stops growing. As your child grows, the brace will need to be replaced, usually every 12 to 18 months.

    Children may feel embarrassed and might find wearing a brace difficult and uncomfortable, it can also make going to the toilet difficult.

    Surgery

    Depending on the degree of curvature, your specialist may recommend surgery. Surgery aims to reduce the amount of curvature of your spine and prevent it from getting worse.

    The most common technique is spinal fusion, where your affected vertebrae are straightened and then fused (joined) together. The curvature is largely corrected by metal rods and screws fitted to your spine.

    Surgery to correct scoliosis can involve a long and complex operation, with a small risk of damage to your spinal cord. In order to make a well-informed decision, you or your child need to be aware of the possible side-effects and the risk of complications. Your surgeon will discuss these with you.

    Other treatments

    Other treatments, such as chiropractic medicine, physiotherapy, yoga and electrical stimulation, may help ease any back pain you might have. However, they cannot correct the curvature in your spine and treat scoliosis.

  • Muscle, bone and joint treatment

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including muscle, bone and joint treatment.

  • Causes Causes of scoliosis

    There are a number of causes of scoliosis.

    Idiopathic

    Around eight in 10 people with scoliosis have the type that has no known cause. This is called idiopathic scoliosis. Ididopathic scoliosis can occur at any age, but it most commonly develops from the age of 10 and is known as adolescent idiopathic scoliosis. The curve is almost always to the right and girls are up to eight times more likely to be affected than boys.

    Less commonly, scoliosis develops in younger children, known as infantile idiopathic scoliosis. The curvature is usually to the left and slightly more boys are affected than girls.

    Idiopathic scoliosis often seems to run in families. About three in 10 people with scoliosis have one or more close family members with the same condition.

    Congenital

    If you're born with an abnormally curved spine, it's called congenital scoliosis. This happens when your spinal bones (vertebrae) don’t form properly. Your spinal bones may be wedged or fused together. It’s not known why this happens and congenital scoliosis doesn’t run in families. The curve often becomes more obvious as a child grows.

    Neuromuscular

    This is due to a condition that affects the nerves or muscles in your back, such as cerebral palsy or muscular dystrophy. The spine is often curved and twisted, making it difficult to walk.

    Other causes

    Other causes of scoliosis, especially in adults, can include damage or uneven growth of your spine caused by osteoporosis, injury, surgery, infection or rarely, tumour of the spine.

  • Complications Complications of scoliosis

    Not everyone who has scoliosis will develop complications and the time it takes for complications to develop will depend on the individual and degree of the curve. Potential complications can include back pain (usually in adults), anxiety and depression because of your change in appearance and breathing difficulties.

  • Prevention Prevention of scoliosis

    There is no way to prevent idiopathic scoliosis. Early detection and treatment, if necessary, helps to prevent it from getting worse.

    At present there is no national screening programme for scoliosis. If you have a history of scoliosis in your family, speak to your GP for more information.

  • Living with scoliosis Living with scoliosis

    How much scoliosis affects you will depend on how severe the curvature of your spine is. For most people who develop idiopathic scoliosis as adolescents, it doesn't cause any life-threatening problems, but it can make life difficult and affect your body image and confidence.

    Family support is crucial and there are support groups you can get in touch with (see Resources). Talking to other children, teenagers and parents who are going through the same thing may help.

  • FAQs FAQs

    Does surgery for scoliosis carry any risks?

    Answer

    All types of surgery carry some risks. Your child's doctor will only recommend surgery for scoliosis if it's considered that the benefits outweigh the risks. The risks depend on the type of procedure your child has, and his or her personal circumstances.

    Explanation

    Severe scoliosis is sometimes treated with a type of surgery called spinal fusion. Spinal fusion helps reduce the curvature of your spine and stops it from getting worse. In spinal fusion, several bones in the spine (vertebrae) are fused and two metal rods are attached to keep the spine straight.
     

    Like all surgery, there are some risks involved. Some problems specific to spinal fusion are listed below.

    • There is a small risk of spinal cord or nerve damage.
    • There is a chance of developing an infection – this can happen months or even years after surgery.
    • Pseudoarthrosis. This is when your spine fails to properly fuse. It can happen years after surgery and you may need another operation.
    • Sometimes the rods attached to your spine may break or come loose. Another operation may be needed to correct this.
    • Some people feel pain in their back following surgery. The cause isn't always known, but further surgery can sometimes help.

    Talk to your orthopaedic surgeon (a doctor who specialises in bone surgery) for advice about whether spinal fusion for scoliosis is the right choice for you or your child.

    Will my scoliosis stay the same or get worse?

    Answer

    If you’re diagnosed with scoliosis before reaching adulthood, it’s very likely the curvature will continue to increase in size (progress).

    Explanation

    Your age, sex and the size and type of curve you have are important factors for predicting how your scoliosis will progress. It's not possible to give concrete predictions for individuals. In very young children, scoliosis often improves without treatment. However, for others it may not and you or your child will require treatment to stop it from getting worse. If you have scoliosis, it’s important that you visit your GP or specialist for regular check-ups. This can help your doctor keep track of the curvature and treat it before it causes any problems.

    Will scoliosis stop my child playing sport?

    Answer

    Not necessarily. Many people diagnosed with scoliosis are able to play sport and do exercise.

    Explanation

    Exercise is good for children – it stimulates muscle and bone development, and helps keep hearts healthy. What your child is able to do will depend on several factors, such as his or her general health, the degree of curvature of the spine and the type of treatment he or she has had. If your child has mild scoliosis, he or she should try and lead a normal life, including taking part in sporting activities. If your child has a back brace, your doctor may advise him or her to take it off during contact sports.

    Talk to your doctor for more advice about any activities your child shouldn't do.

  • Resources Resources

    Further information

    Sources

    • Scoliosis. Scoliosis Research Society (SRS). www.srs.org, accessed 10 January 2012
    • What is scoliosis? Scoliosis Association (UK). www.sauk.org.uk, accessed 10 January 2012
    • Scoliosis. BMJ Best Practice. www.bestpractice.bmj.com, published 15 April 2011
    • Adult Scoliosis. Backcare. www.backcare.org.uk, published 2009
    • Green BN, Johson C, Moreau C. Is physical activity contraindicated for individuals with scoliosis? A systematic literature review. J Chiropract Med 2009; 8(1): 25–37. doi:10.1016/j.jcm.2008.11.001
    • Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. doi:10.1002/14651858.CD006850.pub2.
    • Weiss HR, Goodall D. Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis 2008; 3:9. doi 10.1186/1748-7161-3-9
    • The UK NSC policy on Scoliosis screening in children. UK National Screening Committee. www.screening.nhs.uk, accessed January 2012
    • Idiopathic scoliosis in children and adolescents. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2010
    • Scoliosis. PubMed Health. www.ncbi.nlm.nih.gov, published 21 September 2011
    • Idiopathic scoliosis. eMedicine. www.emedicine.medscape.com, published 27 September 2011
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice 3rd ed. Oxford: Oxford University Press, 2010: 486–87
    • What is scoliosis? British Scoliosis Society. www.britscoliosissoc.org.uk, accessed 23 January 2012
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    Produced by Stephanie Hughes, Bupa Health Information Team, May 2012.

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