Scoliosis

Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward in the upper back and gently inward in the lower back. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.

What causes scoliosis?

There are many types and causes of scoliosis, including:

• Congenital scoliosis. A result of a bone abnormality present at birth
• Neuromuscular scoliosis. A result of abnormal muscles or nerves, frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis
• Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thinning of the bones)
• Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.

Who gets scoliosis?

Around three or four children per thousand of the general population has scoliosis. Less than 0.1% has curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration. Overall, girls are more likely to be affected than boys. Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 to 16. Idiopathic scoliosis may progress during the "growth spurt" years, but usually will not progress to adulthood.

How is scoliosis diagnosed?

Most curves are initially detected on school screening examinations, by a family GP, or by a parent. Some clues that a child may have scoliosis include uneven shoulders, a prominent shoulder blade, uneven waist or leaning to one side. The diagnosis of scoliosis and the determination of the type of scoliosis are then made by a careful bone examination and an X-ray to evaluate the magnitude of the curve.

What is the treatment for scoliosis?

The majority of adolescents with significant scoliosis with no known cause are observed at regular intervals (usually every four to six months), including a physical examination and a low radiation X-ray. Treatments include:

• Casting. Used in early cases of scoliosis and made of plaster of Paris to form a brace that’s attached to a child’s body.
• Braces. Bracing is the usual treatment choice for adolescents who have a spinal curve of more than 25 degrees - particularly if their bones are still maturing and if they have at least two years of growth remaining. The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.
• Surgery. Those who have curves beyond 50 degrees are often considered for scoliosis surgery. The goal is to make sure the curve does not get worse, but surgery does not perfectly straighten the spine. During the procedure, metallic implants are utilised to correct some of the curvature and hold it in the correct position until a bone graft, placed at the time of surgery, consolidates and creates a rigid fusion in the area of the curve. Scoliosis surgery usually involves joining the vertebrae together permanently -- called spinal fusion. In young children, another technique that does not involve fusion may be used since fusion stops growth of the fused part of the spine. In this case, a brace must always be worn after surgery.

Many studies have shown that electrical stimulation, exercise programmes and manipulation are of no benefit in preventing the progression of scoliosis. However, people with scoliosis should stay active and fit.