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Scoliosis


Expert reviewer Mr Roger M Tillman, Consultant Orthopaedic Surgeon
Next review due August 2022

Scoliosis is when your spine permanently bends to the side at a noticeable angle – this can make you look lopsided. It is often called curvature of the spine and is most common in adolescent girls.

Sometimes treatment is needed to prevent the bend growing bigger but it may stop naturally, especially in young children.

What is scoliosis?

Scoliosis means that your spine is curving abnormally. Usually with scoliosis, your spine curves in your lower back or chest, making a C or S shape. Your spine may also twist which can pull on the rib cage causing a humped back.

Symptoms of scoliosis

You may notice scoliosis in yourself or your child. One shoulder – often the right one – may look higher than the other. A shoulder blade or ribs may stick out more. Your middle (waist) may seem off centre because your hips are uneven. Clothes may not fit or hang as well as they did before.

An image showing the effects of scoliosis 

Scoliosis may cause lower back pain that worsens as the bend in the spine increases. Pain may spread down the legs in older people or you may have pins and needles. Sitting or standing for a long time may become increasingly tiring and cause backache.

See your GP if you think you or your child may have scoliosis. This can also rule out other possible causes of any symptoms.

Diagnosis of scoliosis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical and family history. If you are young, they’ll ask about growth spurts and patterns.

If your GP thinks you have scoliosis with a curve of at least 10 degrees, they may refer you to a doctor who specialises in identifying and treating bone conditions. For children, this will be a paediatric spinal deformity specialist.

The orthopaedic specialist may ask you to do a back bend test – you bend forward from your waist. This shows whether or not your shoulders, ribs, hips and waist are level or if your ribs are more prominent on one side. Your specialist may use an instrument called a scoliometer, to measure the curve of your back.

An image showing the scoliosis back bend test

The orthopaedic specialist may want to refer you for further tests, including:

  • X-rays while you’re standing.
  • An MRI scan – particularly if you’ve had muscle weakness or changes in sensation.

These tests can help to identify the cause of a curved spine and the angle of the curve. Scoliosis is defined as a spinal curvature of more than 10 degrees.

Treatment of scoliosis

Treatment for scoliosis depends on your age, how severe the curve in your spine is, if it’s likely to get worse, and how it’s affecting you. In many younger people, the scoliosis gets better on its own and they never need treatment.

The main aims of treatment are to slow or stop the curve progressing and to relieve or prevent symptoms and complications.

Bracing

A brace is a type of corset that covers the upper body, from the armpits to the hips. Braces can only help in people who are still growing. They are usually used for moderate cases of scoliosis. A brace can stop the curve getting worse while the spine develops. It may also help to reduce the curve, particularly when combined with exercises.

Braces are made specifically to fit you and can be either rigid or flexible. The rigid type may be more likely to help.

You are usually advised to wear the brace every day for up to 23 hours, until you stop growing. But that can be hard for children. It’s important for parents to know that wearing the brace for the recommended time means that it is more likely to help.

Casting

In babies and very young children, your specialist may suggest a cast, rather than a brace. These are made from lightweight fibreglass or plaster and worn all the time. As with a brace, they cover the upper body from the armpits to the hips. Holes allow the chest and stomach to expand and enable your child to eat and breathe properly. A plaster cast is put on under anaesthetic. It needs to be changed regularly as your child grows and their spine changes shape.

A tailor-made spinal cast can help guide your child’s spine into a more normal position as they grow. It can stop the curve getting worse and may help to correct it. It can also delay the need for surgery.

Surgery

Your doctor may recommend surgery, which can stop the spine curving and reduce related problems. Whether or not this is suitable for you depends on:

  • your age when your spine first started curving
  • the size of the curve and where it is in your spine
  • how quickly it’s getting worse
  • your response to other treatments
  • increased risks because of your age or other health conditions such as osteoporosis
  • how scoliosis affects you, including pain

The most common type of surgery is called spinal fusion. Metal implants and rods are connected to bones in your spine (vertebrae) to correct the curve. These hold the bones in place until they straighten and join together (fuse).

In older people with degenerative scoliosis, a simpler operation to remove bone can free trapped nerves and relieve pain. This is called decompression. It is sometimes combined with spinal fusion.

For children and adolescents, surgeons can use ‘growth rods’ lengthened every three months as they grow. The lengthening may be done manually in further small operations, through small cuts made in the back. A new type of rod is magnetic and can be expanded using remote control, which is quick and painless. Magnetic rods are used where possible in most hospitals. Once the child is fully grown, the rods are usually removed and a spinal fusion operation carried out.

A spinal fusion operation may sometimes have to be repeated. This may be to extend the area of fusion further up or down the spine. In a small number of cases, this can be due to mechanical failure of the implants, which have to be replaced. With some specific causes of scoliosis, the curve may alter or get worse, meaning you need further treatment.

Surgery is carried out by an orthopaedic surgeon (a doctor who specialises in bone surgery) or spinal neurosurgeon (a doctor who specialises in conditions that affect your nervous system).

Other treatments

Regular exercise is usually part of the treatment of scoliosis because it improves your core strength and fitness. This helps to keep your back muscles strong enough to support your spine. Check with your specialist before starting any new sports or exercises.

You may want to try complementary therapies alongside other treatment. Therapies such as Pilates and the Alexander technique can’t cure your scoliosis but may ease pain and improve posture, mobility and balance. Talk to your doctor first about what’s right for you. Your curve may make it hard to do some of the exercises and you should stop if it hurts. Always find a qualified practitioner, ideally one who specialises in scoliosis.

Specialist physiotherapy exercises are now recommended as part of treatment for mild and moderate scoliosis, including during treatment with a brace. This aims to reduce the spine’s curve or slow down its progression, particularly in children and adolescents, but also in scoliosis that starts in adulthood. Exercises can also help with breathing difficulties related to the scoliosis.

If pain from adult scoliosis is affecting your everyday life, combined local anaesthetic and steroid injections into joints and nerves in your back may help.

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Causes and types of scoliosis

There are several different types of scoliosis. The different types relate to the age you first get it and the cause (even when there doesn’t seem to be one). These two factors can indicate if your scoliosis is likely to get worse and how quickly.

Idiopathic scoliosis

Around eight in 10 people who have scoliosis have idiopathic scoliosis. Idiopathic means there is no known specific cause. Idiopathic scoliosis most commonly develops between the ages of 10 and 18 (adolescent idiopathic scoliosis). Mild scoliosis affects boys and girls equally but moderate to severe scoliosis is more common in girls. It often runs in families. The speed of growth during teenage growth spurts can affect how the spine curves, grows and develops. Once an adolescent stops growing, the curve doesn’t usually get any worse.

Congenital scoliosis

Some people are born with abnormalities in the structure of their spine. This means the spine doesn’t form properly and is more likely to bend as the person grows. This is often linked to problems with other organs such as the kidneys or digestive system because of the way the body develops in the womb.

Syndromic scoliosis

Scoliosis can be part of a recognised syndrome (a condition with a group of common characteristics). People with Down syndrome often have musculoskeletal problems, which can include scoliosis. Marfan syndrome affects the body’s connective tissues and is likely to include scoliosis.

Neuromuscular scoliosis

This type of scoliosis is caused by conditions that affect the nerves or muscles in your back. Examples include spina bifida, cerebral palsy and muscular dystrophy. It's often more severe in people who can't walk easily or at all. If the curve continues to get worse, it usually needs surgery.

Early onset scoliosis

Early onset scoliosis affects young children. It's known as infantile scoliosis in babies and children under three, and juvenile scoliosis if it develops up to age 10. It may be any of the types above. In infantile scoliosis, the spine usually curves to the left, from the chest area.

Adult degenerative scoliosis

This is becoming more common because people are generally living longer. If you had idiopathic scoliosis as a child, you may get it again because of wear and tear as you age. But normal wear of discs and joints may mean you get scoliosis for the first time as an older adult.

If you are developing a curvature of the spine, you may find it harder to stand up straight. You may also notice your ribcage, hip or waist sticking out. Adult scoliosis can be painful or cause pins and needles because worn joints and discs in your back press on nerves.

Other causes

Spinal cord damage at any age increases risk of scoliosis. This may be through injury, infection or another health condition such as osteoporosis or tuberculosis.

Complications of scoliosis

Complications can develop because the curve of your spine is affecting your ribcage and internal organs. If the scoliosis restricts the lungs, this can cause breathing difficulties in both adults and children, although this is rare in adolescent onset scoliosis.

Scoliosis is also linked to hiatus hernias and other digestive problems because the stomach gets squashed. But most cases are treated early enough to avoid these complications.

In older people, scoliosis can cause problems walking.

Prevention of scoliosis

Scoliosis can’t be prevented but early diagnosis and treatment may stop it getting worse or even correct it.

There’s currently no screening programme for scoliosis in the UK. But the chances of developing scoliosis without yourself, family or friends noticing are very small. People usually spot it in themselves or their children and see their GP. There’s no evidence that treating any earlier than that would be helpful. Doctors are also concerned that screening could lead to children having X-rays that they don’t need.

Any routine examination of a child or adult may detect early signs, especially in someone already diagnosed with a syndrome or condition linked to scoliosis.

Living with scoliosis

How scoliosis affects your daily life depends on the severity of the curve of your spine and the treatment you have.

Poor posture can cause pain and muscle weakness and change the way you move. But good posture may be difficult with scoliosis. You may find you bend your knees and tilt your pelvis back to avoid leaning forward or sideways. Instead, try to spread your weight evenly keeping your neck straight and trying not to tilt your pelvis. Keep your hips level as much as you can. Looking in a mirror can help you to check your posture, and you can ask your family for help too.

It can help to make small changes to everyday tasks that you find difficult or tiring. Try to avoid standing, carrying heavy loads or bending over from the waist as these all put pressure on the spine. Here are some suggestions:

  • organise rooms with things you need in easy reach
  • don’t overdo any activity and take regular breaks
  • make life easier with the right equipment, such as an upright vacuum cleaner
  • choose seating that makes you sit with your knees slightly lower than your hips and your feet flat on the floor

Scoliosis can also affect your body image and confidence. See the links in our Other helpful websites section for advice and support groups. It may help to share experiences with people going through the same thing.

Frequently asked questions

  • All surgery has some risks. In scoliosis surgery, these include:

    • damage to tissue covering the spinal cord and nerves, which may cause problems with movement
    • problems with wound healing and infection
    • allergic reaction and other problems related to metal implants
    • back pain

    Breathing problems after surgery are more likely if you’ve got neuromuscular scoliosis. Infection following surgery for adolescent idiopathic scoliosis is rare.

    Older people are more at risk of damage to the spinal tissue during scoliosis surgery. They are also more likely to have other health conditions in addition to scoliosis. This can increase risk of other complications, such as deep vein thrombosis (DVT).

    Surgery might not always be successful. It’s important to talk to your surgeon about the pros and cons of the operation and decide what’s right for you. It may not be the right option if you’ve got osteoporosis – a condition that weakens your bones.

    Your specialist orthopaedic doctor or surgeon will always consider if the benefits of surgery outweigh the risks. For younger children, they will also consider the age at which the child would benefit most. Your doctor may want to do a CT scan and other tests to check how your body will cope with a complex operation.

  • Scoliosis mostly doesn’t affect pregnancy and will not stop you having a normal birth. It also doesn’t make a premature delivery or unplanned caesarean section any more likely. In most cases, you should be able to have an epidural if you want one, although this can potentially be more of a problem if you’ve had previous spinal surgery.

    Having a baby is unlikely to make your scoliosis worse, either during your pregnancy or after labour.

    Always talk to your midwife or obstetrician about your scoliosis beforehand, and tell your anaesthetist if you’re considering an epidural for pain relief or a caesarean section.


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  • Reviewed by Marcella McEvoy, Specialist Health Editor, and Liz Woolf, Freelance Health Editor, Bupa Health Content Team, August 2019
    Expert reviewer, Mr Roger Tillman, Consultant Orthopaedic Surgeon
    Next review due August 2022



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