Although everyone’s spine is individual with its own curves, some people have side to side curves that twist the spine into more of a ‘C’ or ‘S’ shape. This twisting can make the waist and shoulders uneven.
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.
Scoliosis can progress quickly when the skeleton is still growing or during hormonal changes or severe degeneration. Skeletal maturity occurs at approximately 14 - 17 years old for women and 18 - 22 years for men, and the bones and spine are no longer malleable. Therefore, the approach to treatment is different for adults as it is for children. For adult, bracing is used for pain relief and aesthetic improvement and curve prevention, rather than reducing the cobb angle. In children, bracing treatment, if started young enough and depending upon maturity and magnitude of curvature, can reduce the curve and cobb angle and significantly reduce the need for surgery in later life.
Scoliosis affects several age groups differently:
- Infantile scoliosis: occurs before the age of three years old, more frequent in boys.
- Juvenile scoliosis: more frequently in girls between the age of 3 and 10 with a high risk of deterioration into adolescence.
- Adolescent idiopathic scoliosis (AIS): happens between the ages of 10 and skeletal maturity with a high risk of progression
- Adult scoliosis: after puberty when the bones of the spine have hardened
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. Symptoms can include:
- A visibly curved spine
- One shoulder higher than another
- Hip or waist unevenly sticking out; seeming more prominent than the other
- Rib cage sticking out on one side – also known as ‘rib hump’ - especially noticeable from the back
- Difficulty standing up straight
- Back pain
- A difference in leg length
- A prominent rib cage
- Pain in the legs or pins and needles, caused by pressure in the nerves.
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. It is further possible to have more compensatory curves at the top and bottom of the spine.
As scoliosis is a three-dimensional condition and the spine is always trying to compensate there are numerous potential curve variations. However, the most common curve is the right thoracic curve.
Early diagnosis of scoliosis is important as with non-operative treatment like bracing and exercises, the more growth, the more effective the outcome.
At the initial consultation 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. The scoliometer is a useful tool for monitoring our patients while reducing the need for x-rays.
The criteria for treatment in relation to cobb angle:
- 10-20 degrees – intensive or advanced self-management of Schroth therapy (specialised physiotherapy) and postural overcorrection needed to halt or reduce these curves (depending upon maturity of the bones)
- 20-25 degrees – closely monitor and provide same program with close monitoring of progression but start to consider effective bracing (depending upon bone maturity)
- 25+ degrees – effective bracing and intensive or advanced self-management of Schroth therapy (specialised physiotherapy)
- Adult patients – self-management and Schroth therapy (specialised physiotherapy) and postural overcorrection. Bracing is provided if postural pain is identified or aesthetics is the main issue.
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, may reduce the cobb angle but cobb angles will need to be monitored closely.
The LOC Scoliosis Team is headed by David Williams, Deborah Turnball and Sally Hews