Doc Talk: Scoliosis

What Is Scoliosis?

Scoliosis is an abnormal lateral or sideways curve of the spine.  

The healthy spine has three natural curves that form a loose ‘S’ shape: at the neck, upper back and lower back. From the rear, the healthy spine should look straight. When a person has scoliosis, they have an abnormal sideways curve that makes the spine look tilted when  viewed from the back. It can occur at any age, but tends to start in children and teenager —  90% of patients are female. Scoliosis can get better without any treatment, but can also get worse with time. People with scoliosis may need to see their doctor regularly to check on its progress. Early diagnosis and treatment is important. 

Scoliosis is not contagious and is not simply caused by bad posture, a soft mattress, carrying a heavy school bag or eating junk food. Scoliosis tends to run in families. When a curve is detected in one member of the family, other children should also be examined by the family doctor. If there is a history of a blood  relative, especially a female cousin, having been treated for scoliosis by brace wearing or  surgery, then this strengthens the case for spinal examination as a regular health check  between 10 and 13 years of age. Scoliosis which requires treatment is far less common in  boys than in girls. The ratio of boys to girls requiring treatment is about 1 to 10. 

Symptoms

The symptoms and signs of scoliosis include: 

• Head not centered over the body 
• Uneven shoulders, or one shoulder blade that sticks out more than the other ∙ uneven waist creases  
• Unusual gaps between one arm and the trunk
• One hip higher than the other
• An obvious exaggerated curve of the spine
• An uneven posture
• Back pain

Causes

Most of the time, the cause is unknown, and scoliosis develops in otherwise healthy children. Sometimes it is congenital, meaning it is present at birth, accounting for about 80% of cases. It is sometimes caused by problems with the nerves and muscles, such as with cerebral palsy or muscular dystrophy.

Diagnosis

Your doctor can diagnose scoliosis simply with a physical examination. 

If your doctor thinks you or your child has scoliosis, they may refer you to an orthopedic. The specialist will do a physical examination, and may order tests such as  an X-ray, CT scan or MRI. 

Treatment

Treatment usually aims to straighten the spine to improve the person’s appearance. The choice of treatment depends on the severity of the scoliosis and the age of the person affected. Most cases of scoliosis are mild, and may need no further investigation or treatment.

If more severe, regular check-ups may be require, and the treatment may involve wearing a brace or a plaster cast, which can help prevent the curvature getting worse. 

For some people, the curvature is so severe that surgery is suggested. That might involve the insertion of metal rods to straighten the spine, or surgery to fuse some of the bones together. 

Physiotherapy and specific exercises can help ease pain, but there is no scientific evidence that physical therapy (exercise programs) and spinal manipulation (chiropractic adjustments) will either correct a significant scoliosis or halt its  progression.  

What Happens If Severe Scoliosis Is Not Treated?

The curve may increase unnoticed during the growing years. Moderate and severe curves  may also increase in adult life, on average 15 to 30 degrees. Some curves may increase with  pregnancy. Severe pain, physical deformity and wear and tear arthritis may occur during  middle life. Early detection is important.  

Psychological Impact Of Scoliosis

Children and teenagers with scoliosis who need to wear a brace or have surgery may  experience problems with self esteem and body image, and may need emotional support.