Scoliosis is the medical term that describes the abnormal twisting and curvature of the spine. It occurs most often during the growth spurt just before puberty. It affects around three to four children in every 1,000 in the UK and is most typically seen in children between the ages of 10 and 15. It is also more common among females than males.
In 8 out of 10 cases there is no known cause; this is known as idiopathic scoliosis. The majority of the rest of cases are caused by medical conditions: such as cerebral palsy, muscular dystrophy, Ehlers-Danlos syndrome and Marfans syndrome.
Although most common in older children, between 10-15% of all idiopathic scoliosis in children is diagnosed in children aged between 4 and 10. This is often referred to as Juvenile Idiopathic scoliosis. Boys are affected slightly more than girls and the curve is often left-sided.
Scoliosis may first be noticed by a change in the appearance of a child’s back. Visual symptoms can include:
- A visibly curved spine
- One shoulder higher than another
- A difference in leg length
- A prominent rib cage
- One shoulder or hip being more prominent than the other
Each scoliosis curve is unique. The spine may curve to the left or right and it can happen in different parts of the spine. If it is in the chest area it is called ‘thoracic’ scoliosis while if it is the lower part of the spine it is called ‘lumbar’ scoliosis. It is also possible to have two curves. This is called a double curvature and the spine may look like an S shape from behind.
As scoliosis is a three dimensional condition there are numerous potential curve variations. However the most common curve is the right thoracic curve.
Early diagnosis of scoliosis is important as non-operative treatment like bracing can be very effective.
At the initialconsultation we will conduct a detailed clinical assessment to assess posture/leg length/progression factor of the curve/flexibility of the body and then discuss the most appropriate treatment. If you have already been diagnosed with scoliosis you will need to bring with you a recent X-ray of your spine. The existence of scoliosis is established by measuring the Cobb angle of the spinal curves. The Cobb angle was first described in 1948 by Dr John R Cobb, an American orthopaedic surgeon. A Cobb angle of 10° is regarded as the minimum angulation to define scoliosis.
We use a scoliometer to measure the angle of trunk rotation. This is a small non-invasive device that is placed over the spine while the patient being measured is in a forward bending position. As it provides a reading in degrees, it is important not to confuse the Cobb reading with a scoliometer reading. We find the scoliometer a useful tool for monitoring our patients while reducing the need for x-rays.
Mild cases of scoliosis may self-correct as a child grows. However it is important that any existing curvature is monitored closely to check progression particularly during periods of rapid growth during puberty.
For more serious cases (Cobb angles in excess of 25°) we have established a non-surgical evidence based treatment package which incorporates the Gensingen© brace and a comprehensive Schroth method physiotherapy programme. Juvenile curves can also be treated successfully with the Gensingen brace.
For less serious cases (Cobb angles below 25°) Schroth physiotherapy may be sufficient to prevent progression, again the patient’s curvature will be closely monitored.
The LOC Scoliosis Team is headed by David Williams, Deborah Turnball and Sally Hews