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Scoliosis

Scoliosis is when your spine permanently bends to the side at a noticeable angle – this can make you look lopsided. Usually with scoliosis, your spine bends at your lower back or chest area making a C or S shape. Your spine may also twist or tilt forward or backwards.

Scoliosis is most common in adolescents, and is more common in girls. Sometimes treatment is needed to prevent the bend growing bigger, but it may stop naturally, especially in younger people.

Idiopathic scoliosis
Scoliosis is a sideways curve to the spine. Idiopathic means that the cause is unknown

Details

  • Symptoms Symptoms of scoliosis

    The main way to spot scoliosis is by noticing changes in how your body looks. One shoulder – often the right one – may look higher than the other. A shoulder blade or your ribs may stick out more. Your middle (waist) may seem off centre because your hips are uneven.

    When babies and young children develop scoliosis, their parents may notice these changes, or health professionals may spot them in routine checks. Adults and older children usually see the early signs during everyday activities, especially when washing, dressing or looking in the mirror. Clothes may not fit or hang as well as they did before.

    An image showing the effects of scoliosis 

    A symptom of scoliosis can be pain in your lower back that gets worse as the bend in your spine increases. This pain may spread down the legs in older people. You may notice a feeling of tiredness in your back after sitting or standing for a long time.

    There may be other symptoms if scoliosis is part of a specific syndrome.

    You should see your GP for advice if you think you or your child may have scoliosis. This can also rule out other possible causes of any symptoms.

  • Diagnosis 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 your growth spurts and patterns.

    If your GP thinks you may have scoliosis, they’ll refer you to an orthopaedic specialist. This is a doctor who specialises in identifying and treating bone conditions. Children with suspected scoliosis may be referred to a paediatric spinal deformity specialist.

    The orthopaedic specialist may ask you to do the Adams' forward bend test (sometimes called a back bend test). During this test, you bend forward from your waist, with the palms of your hands together. This will help show if your shoulders, ribs, hips and waist are level or not, or if your ribs are more prominent on one side. Your specialist may use an instrument called a scoliometer, which is placed against your back to measure the curve.

    An image showing the scoliosis back bend test

    The orthopaedic specialist may want to refer you for further tests, including the following.

    • X-rays of your back – these are taken while you’re lying down and while you’re standing.
    • A CT scan or MRI scan – your doctor is likely to want you to have this test if you’ve experienced any muscle weakness or changes in sensation.

    These tests allow your doctor to look at your spine in more detail. They can help to identify what might or might not be the cause of a curved spine. Using the X-rays, your doctor can measure what’s called the Cobb angle. This is a method for diagnosing scoliosis, which is defined as a spinal curvature of more than 10 degrees.

  • Treatment Treatment of scoliosis

    Treatment for scoliosis depends on how severe the curve in your spine is, whether or not it’s likely to get worse, and its overall effect on you. Your age is a factor too. In children, so is their stage of development and whether or not they’re still growing.

    The main aims of treatment are to slow or stop the curve’s progression, and relieve or prevent symptoms or complications like pain or breathing difficulties.

    Observation

    Quite often, mild scoliosis clears up without treatment, especially idiopathic scoliosis in children under three. Adolescent idiopathic scoliosis mainly coincides with growth spurts and the curve is unlikely to get worse once the spine is fully developed.

    In these cases, observation may be enough. An examination and possibly an X-ray every four to six months will allow the doctor to monitor the curve and any symptoms. These check-ups will be needed less often once the child stops growing.

    Bracing

    A common scoliosis treatment for curves of 21–35 degrees – particularly for children – is wearing a specially fitted brace. It can’t correct the curve, but may stop it getting worse while the spine develops.

    A brace doesn’t act directly on the spine but reduces stress on it. This helps cartilage between the bones in your spine (vertebrae) to grow properly. Braces can be either rigid or flexible and some are suitable for children under three. They need to be correctly adjusted.

    The general advice is to wear the brace for at least 18 hours a day until you stop growing. But that can be hard, especially for children.

    Doctors aren't sure how well braces work. There’s evidence that rigid types are more effective than elastic ones, especially for more severe curves.

    Casting

    An external, tailor-made spinal cast can help guide a child’s spine into a more normal position as they grow. It may at least stop the curve getting worse.

    Casts are made from lightweight fibreglass or plaster and worn all the time. They start under the arms and cover the upper body. Holes allow the chest and stomach to expand and the child to eat and breathe properly.

    Even very young children can wear a cast, and parents may find it easier than making them put a brace on every day. The cast needs to be changed regularly as they grow and their spine changes shape.

    Surgery

    Your doctor may recommend surgery to treat scoliosis. It can stop the spine curving and reduce related problems. They will consider:

    • what age you were when your spine first started curving
    • the size of the curve and where it begins (your chest or back)
    • how quickly it’s getting worse
    • how you’ve responded 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. They hold the bones in place until the bones straighten and fuse (join) together.

    There are different ways to carry out spinal fusion. Some procedures are more complex than others. For instance, an operation may also involve cutting and reshaping vertebrae. In adults, if pain is the main problem, there’s a simpler procedure called decompression to relieve this.

    Surgical treatment for children and adolescents may not initially fuse the bones together. Instead surgeons can use ‘growth rods’ lengthened every six months as the person develops. This may be done manually and involves making small cuts in their back. But a new type of rod avoids surgery or anaesthetic. It’s magnetic and can be expanded using remote control, which is quick and painless.

    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, including the spine).

    See our FAQs for information about surgery risks and repeat operations.

    Other treatments

    If you’ve got scoliosis, regular exercise can help by improving your core strength and fitness. Being fit and active keeps your back muscles strong. But check with your specialist if there’s anything you shouldn’t be doing before, during and after specific scoliosis treatment such as surgery or wearing a brace.

    You may want to try complementary therapies alongside treatment you’re getting through your orthopaedic specialist. These therapies can’t affect your scoliosis but Pilates and the Alexander technique may ease pain and improve your 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 shouldn’t push yourself. Always find a qualified practitioner, ideally one who specialises in scoliosis.

    A physiotherapist will often work with your doctor to create a special exercise programme as part of your treatment. This aims to reduce the spine’s curve or slow down its progression, particularly in children and adolescents.

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

  • Muscle, bone and joint treatment

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

  • Causes and types Causes and types of scoliosis

    The various types of scoliosis mostly 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 how scoliosis will progress.

    Idiopathic scoliosis

    Around eight in 10 people who have scoliosis have idiopathic scoliosis. You can get idiopathic scoliosis at any age but it most commonly develops between the ages of 10 and 18 and is known as adolescent idiopathic scoliosis. It is closely linked to the time when young people go through their biggest ‘growth spurts’. The speed of growth can affect how the spine curves, grows and develops. Once an adolescent stops growing, the curve usually doesn’t get any worse. More girls get this type of scoliosis than boys.

    Idiopathic scoliosis often seems to run in families. For instance, girls whose mothers had adolescent idiopathic scoliosis are more likely to get it than other girls.

    Congenital scoliosis

    Some people are born with abnormalities in the structure of their spine so it doesn’t form properly, and is more likely to bend as the person grows. This is called congenital scoliosis. It can involve weaknesses in the muscle, bones or ligaments.

    Syndromic scoliosis

    Scoliosis can be part of a recognised syndrome (a condition with a group of common characteristics). For instance, one in five people with Down's syndrome has musculoskeletal problems, which could include scoliosis. Marfan’s syndrome affects the body’s connective tissues and is likely to include scoliosis.

    Neuromuscular scoliosis

    This type of scoliosis is caused by a condition that affects the nerves or muscles in your back. Examples include spina bifida, cerebral palsy or muscular dystrophy. It's often more severe in people who can't walk easily or at all.

    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 before the age of 10. It can be congenital, idiopathic, syndromic or neuromuscular. In infantile scoliosis, the spine usually curves to the left, from the chest area.

    Adult degenerative scoliosis

    Increasing numbers of adults develop scoliosis because people are generally living longer. If you had idiopathic scoliosis when you were younger and still growing, you’re more likely to get it again as you age. But normal wear and tear on your body, especially to discs and joints, may mean you get scoliosis for the first time as an older adult.

    Losing muscle strength and flexibility in your joints can lead to stooping, especially if you’re over the age of 60. You may find it harder to stand up straight as well as noticing your rib cage, hip or waist sticking out. Adult scoliosis can be painful because the worn joints and discs in your back put pressure on nerves.

    Other causes

    At any age, damage to your spinal cord makes you more likely to develop scoliosis. This may be through injury, infection, or another health condition such as osteoporosis or tuberculosis.

  • Complications Complications of scoliosis

    Complications can develop when the curve of the spine is severe enough to affect your rib cage and internal organs, including your heart. If the scoliosis restricts the lungs, this can cause breathing difficulties in both adults and children.

    Scoliosis is also linked to hiatus hernias when the abdomen is pushed up to the chest area, and digestive problems because your stomach gets squashed.

    Other possible complications of scoliosis, particularly in older people, are back pain and problems walking.

  • Prevention 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 routine screening programme for scoliosis in the UK. The thinking is that screening is no more helpful than seeing your GP as soon as you notice any signs of scoliosis. Doctors also want to avoid doing tests that may not be needed, especially on children whose scoliosis may get better on its own.

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

  • Living with scoliosis Living with scoliosis

    How scoliosis affects your daily life and overall health usually depends on the shape and severity of the curve of your spine. What treatment you have for scoliosis may have an impact too.

    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 check your posture, and you can ask your family too.

    It can help to make small changes to everyday tasks. These can be tiring, especially if scoliosis causes you pain or mobility problems. Try to avoid bending over from the waist – this puts pressure on the spine. So does standing a lot or carrying heavy loads.

    Tips to make things easier for yourself include:

    • organising rooms so things you often need are in easy reach
    • not doing too much at once and making sure to take regular breaks
    • choosing the right equipment, like an upright vacuum cleaner
    • using chairs that mean you sit with your knees slightly lower than your hips and your feet flat on the floor

    Scoliosis can also affect how you feel, including 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 of different ages and families going through the same thing.

  • FAQ: Surgery risks Does surgery for scoliosis carry any risks?

    There are risks involved in spinal fusion, as in all surgery. They include:

    • damage to tissue that covers the spinal cord and nerves; this can affect specific muscles causing problems with movement
    • the wound failing to heal or getting infected
    • problems with metal implants, such as an allergic reaction
    • back pain

    Some post-operative complications, such as breathing problems, are more likely if you’ve got neuromuscular scoliosis. But infection following surgery for adolescent idiopathic scoliosis is rare.

    Older people are more at risk of damage to the spinal tissue, infection and problems with implants. Operations on adults can be more complex. Older people are more likely to have health conditions in addition to scoliosis. This can lead to other complications, such as deep vein thrombosis and urinary tract infections.

    Surgery may not be the right option for you if you’ve got osteoporosis, which weakens your bones.

    Your specialist orthopaedic doctor or surgeon will consider if the potential benefits of surgery outweigh the risks, particularly in younger children who are still growing. Spinal curves in about seven in 10 children with juvenile idiopathic scoliosis get worse and eventually need surgery.

    Your doctor may want to do a CT scan and other tests to check how your body will cope with a complex operation. They may want to look at your breathing, for example, and how strong your bones are.

    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.

  • FAQ: Repeat operations Will I need more than one operation for my scoliosis?

    It depends on the cause of your scoliosis and other factors such as your age. For example, conditions that lead to syndromic and neuromuscular scoliosis may also lead to changes and complications as you get older. So even if surgery has been successful to start with, the curve in your spine may alter or get worse, meaning you need further treatment.

    A spinal fusion operation may not always work. For example, your spine may not fuse properly or implants holding the spine in position can loosen. Rods can break and have to be repaired or replaced.

    Children and adolescents who have surgery to fit growth rods may need regular operations to lengthen the rods as their bodies develop. But new types of rod can make this unnecessary. Adolescents may undergo a spinal fusion procedure to fix the realigned bones in place once their spine has stopped growing.

    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, including the spine).

    Ask your surgeon for advice about whether spinal fusion for scoliosis is the right choice for you.

    Will scoliosis stop my child playing sport?

    Answer

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

    Explanation

    Exercise is good for children – it improves bone health, self-confidence and helps keep their hearts healthy. What your child is able to do will depend on several factors. These will include their general health, how severe the curve of their spine is and the type of treatment your child has had. If your child has mild scoliosis, he or she should try to lead a normal life, which includes taking part in sporting activities. If your child has a back brace, your specialist doctor may advise him or her to take it off during contact sports.

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

    Does surgery for scoliosis carry any risks?

    Answer

    All types of surgery carry some risks. Your specialist doctor or surgeon will only recommend surgery for scoliosis if it's considered that the benefits outweigh the risks. The risks depend on the type of procedure you have and your personal circumstances.

    Explanation

    Severe scoliosis is sometimes treated with a type of surgery called spinal fusion. Spinal fusion helps reduce the curve of your spine and stops it from getting worse. In spinal fusion, your surgeon will fuse (join together) several bones in your spine (vertebrae) and attach metal rods to keep it straight.

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

    • There’s a small risk of spinal cord or nerve damage.
    • There’s 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. You might need to have another operation to correct this.
    • Some people feel pain in their back following surgery. The cause isn't always known, but further surgery can sometimes help.

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

  • FAQ: Scoliosis and pregnancy Will scoliosis cause problems in pregnancy or labour?

    Most of the time, scoliosis has no effect on pregnancy and will not stop you having a normal birth. But the severity, shape and site of the curve may put pressure on your uterus. And if your scoliosis affects your chest, you may need extra help with your breathing in labour.

    Talk to your midwife about it beforehand. You should also let your anaesthetist know if you’re considering an epidural for pain relief or a caesarean section.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Scoliosis. BMJ Best Practice. bestpractice.bmj.com, last updated October 2016
    • UK NSC recommendations on adolescent idiopathic scoliosis. UK National Screening Centre. legacyscreening.phe.org.uk, last reviewed August 2016
    • Scoliosis and kyphosis. PatientPlus. patient.info/patientplus, last checked December 2014
    • Bettany-Saltikov J, Weiss HR, Chockalingam N, et al. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database of Systematic Reviews 2015, Issue 4. doi:10.1002/14651858.CD010663.pub2
    • Adult degenerative scoliosis. British Scoliosis Society. www.britscoliosissoc.org.uk, accessed 23 January 2017
    • Syndromic scoliosis. Scoliosis Association (UK). www.sauk.org.uk, reviewed January 2013
    • Musculoskeletal problems: Scoliosis. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Back pain – (without radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Idiopathic scoliosis. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2013
    • Constipation in children. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2015
    • Amenorrhoea. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2014
    • Adolescent idiopathic scoliosis. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 23 January 2017
    • Down Syndrome clinical presentation. Medscape. emedicine.medscape.com, updated January 2017
    • Neuromuscular scoliosis. Medscape. emedicine.medscape.com, updated September 2016
    • Infantile scoliosis. Medscape. emedicine.medscape.com, updated November 2015
    • Shaw R, Skovrlj B, Cho S. Association between age and complications in adult scoliosis surgery: An analysis of the Scoliosis Research Society morbidity and mortality database. Spine 2016; 41(6):508–14. emedicine.medscape.com
    • Spinal cord injury and aging. Medscape. emedicine.medscape.com, updated April 2016
    • Hiatus hernia. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 23 January 2017
    • Frequent asked questions. International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). www.sosort.mobi, accessed 22 January 2017
    • Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews 2015, Issue 6. doi:10.1002/14651858.CD006850.pub3
    • The MAGEC system for spinal lengthening in children with scoliosis. National Institute for Health and Care Excellence (NICE), June 2014. www.nice.org.uk
    • Surgery for degenerative scoliosis. Scoliosis Association (UK). www.sauk.org.uk, reviewed December 2015
    • Silva F, Lenke L. Adult degenerative scoliosis: evaluation and management. Neurosurgical Focus 2010; 28(3):E1. doi:10.3171/2010.1.FOCUS09271
    • Scoliosis: Know the facts. Scoliosis Association (UK). www.sauk.org.uk, reviewed December 2015
    • Complementary therapies. Scoliosis Association (UK). www.sauk.org.uk, reviewed December 2015
    • Berdishevsky H, Lebel V, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis and Spinal Disorders 2016; 11(20). doi:10.1186/s13013-016-0076-9
    • Managing day to day tasks. Scoliosis Association (UK). www.sauk.org.uk, reviewed December 2015
    • Posture and positioning. Scoliosis Association (UK). www.sauk.org.uk, reviewed December 2015
    • Lebel D, Sergienko R, Wiznitzer A, et al. Mode of delivery and other pregnancy outcomes of patients with documented scoliosis. J Matern Fetal Neonatal Med 2012; 25(6); 639–41. doi:10.3109/14767058.2011.598587
    • McNaughton S, Staggs R, Heinz D, et al. Pregnancy, fertility, and contraception risk in the context of chronic disease: Scoliosis. J Nurse Pract 2008; 4(5): 370–6. emedicine.medscape.com
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    Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, February 2017
    Expert reviewer Mr Roger M Tillman, Consultant Orthopaedic Surgeon
    Next review due February 2020

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