Scoliosis
Sideways (Lateral) Curvature of the Spine

What is scoliosis?

If you look at someone from behind, the spine should look straight up and down. If the spine has a sideways curve, it is called a scoliosis. The curve can bend to the left or to the right. The word scoliosis comes from the Greek word meaning crooked. The severity of the curve can vary from very mild and barely noticeable, to severe.

The curve can be in the lower part of the spine (a lumbar curve), in the upper part of the spine (a thoracic curve), or go from the upper to lower part of the spine (a thoracolumbar curve). In some cases there is a double curve - like an S shape.

What is the difference between scoliosis and kyphosis?
If you look at someone from the side, normally there are three slight front-to-back curves in the spine - one in the neck, one in the chest section, and one in the lower back. An abnormal more pronounced front-to-back curve is called a kyphosis. This is different to a scoliosis - see separate leaflet called kyphosis.

What are the types and causes of scoliosis?

Non-structural scoliosis (functional or postural scoliosis)
In this type the spine is structurally normal, but looks curved because of another condition such as differing leg length, muscle spasm in the back muscles, etc. The curve is usually mild and it changes or goes away when the person bends sideways or forwards.

Structural scoliosis
In these cases the curve is fixed and doesn't go away when the person changes position. There are different types

• Idiopathic. This means the cause is not known. More than 8 in 10 cases of scoliosis are idiopathic.
• Neuromuscular. This means the curve is caused by a condition which affects muscles or nerves of the back. For example, it may occur in some cases of muscular dystrophy, polio, cerebral palsy, or neurofibromatosis. Each of these conditions has other symptoms and problems in addition to a scoliosis.
• Osteopathic. This means as a result of a bone abnormality.
• Congenital. This means the spine does not form properly when a baby develops in the womb.

The rest of this leaflet is about the common type - idiopathic scoliosis.

Who gets idiopathic scoliosis?

Idiopathic scoliosis can develop at any stage in childhood. It is not known how or why it develops. It is not due to poor posture and you cannot prevent it.

It most commonly develops during the growth spurt of puberty and early adolescence. It is quite common. About 1 in 20 children between the ages of 9 to 14 develop some degree of scoliosis. Most cases are mild and do not need treatment other than being checked from time to time to see if it is getting worse. About 4 in 1000 children develop scoliosis severe enough to need treatment. Mild scoliosis affects about the same number of boys and girls. However, moderate or severe scoliosis is more common in girls.

Idiopathic scoliosis is not a straightforward hereditary condition. However, there is some genetic factor in some cases. In about 1 in 4 cases there are one or more other family members with the same condition.

What are the symptoms of idiopathic scoliosis?

In most cases the onset of the scoliosis is gradual and usually painless. Sometimes a mild to moderate scoliosis can develop without being noticed by the child or his or her parents. This is often because the condition usually develops at the age when children often become more self-conscious (age 9 to 14). Parents and others are not likely to see a naked back and see the problem.

However, the more severe a scoliosis becomes, the more disfiguring it can become. This is because when the spine curves sideways, as the curve becomes more severe, the small bones that make up the spine (the vertebrae) also twist round. This pulls any attached muscles, ligaments and ribs round with them. As a consequence:

• If the scoliosis is in the chest (thoracic) region the ribs and shoulder blade stick out like a bulge on one side of the back. The more severe the scoliosis, the larger the bulge. Also one shoulder may hang lower than the other, and one shoulder blade may be higher than the other.
• If the scoliosis is in the lumbar (lower back) region it can make the pelvis thrust forward on one side and one leg may appear to be shorter than the other.

If scoliosis becomes severe and is not treated, it can cause problems later in life. For example, persistent back pain may develop, and breathing problems or heart problems may develop if the deformity in the chest region is severe.

How is idiopathic scoliosis diagnosed and assessed?

In some cases of scoliosis the diagnosis is obvious. However, some mild cases are not so obvious. A quick test which a doctor or nurse may do is simply to ask the child to bend forward. A bulge on the back of the chest is more obvious when bending forward. If a doctor or nurse diagnoses scoliosis you will normally be referred to a specialist.

X-ray pictures can show the spine clearly. From the pictures a specialist can assess the angle of the curve. This gives an idea of the severity of the condition and the likelihood of it getting worse.

What is the treatment for idiopathic scoliosis?

Treatment depends on various factors such as the patients age, whether they are still growing, the severity of the curve, the exact location of the scoliosis (for example, upper or lower back) and the chance that it may progress. Treatment options include observation, bracing and surgery.

Observation and review
Most cases are mild and do not need any treatment. Mild cases may stay the same, get better in time, or get worse as the child grows. Therefore, a specialist may arrange regular reviews to make sure that the condition does not get much worse.

• For children diagnosed around puberty or early teens - the reviews may be every 3-6 months or so. Once the main bone growth ends after puberty, scoliosis does not usually become worse. In most cases there is usually no restriction on sports or other activities. In some cases a specialist may advise against certain activities such as to avoid heavy contact sports or gymnastics.
• For children diagnosed as babies - the review may be more frequent. In many cases diagnosed in babies, the condition gets better on its own as the child grows. However, some cases become worse rather quickly and treatment may be needed to prevent it becoming severe.

Back braces
If the scoliosis is moderate or progressing then a back brace may be advised. A brace does not cure a scoliosis. The aim of a brace is to prevent the scoliosis from getting worse as the child grows. So, it is more commonly used when scoliosis is diagnosed before or early on in the growth spurt of puberty. If used, a brace is worn most of the day and night. You can do most normal activities whilst wearing a back brace. However, the use of back braces is controversial and your specialist will advise on the pros and cons.

Surgery
An operation on the spine is the only way to correct a scoliosis. It is a long and major operation and usually only considered for severe cases. However, the long-term results of the operation are usually good.

Further help and information

Scoliosis Association UK (SAUK)
2 Ivebury Court, 325 Latimer Road, London, W10 6RA
Helpline: 020 8964 1166    Web: www.sauk.org.uk

© EMIS and PIP 2004   Updated: June 2004   Review Date: July 2005   CHIQ Accredited