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 occurs in a number of different age groups:
- Infantile scoliosis: occurs before the age of three years old, more frequent in boys. We would assess infants in this age group on an individual basis with the involvement of your consultant.
- Juvenile or early onset adolescent idiopathic 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
Different Types of Scoliosis
In addition to defining scoliosis in relation to the age of the sufferer or whether it is idiopathic or symptomatic, scoliosis is also defined according to where in the spine the condition is and what kind of curve it is.
Location of scoliosis in the spine
- Cervical spine scoliosis – upper back
- Thoracic spine scoliosis – middle back
- Lumbar spine scoliosis – lower back
- Thoracolumbar scoliosis – curvature includes vertebrae in both the middle and upper back
- Dextroscoliosis – a curve to the right when viewed from behind, usually occurs in the middle back
- Levoscoliosis - a curve to the left when viewed from behind, usually occurs in the lower back
- Kyphoscoliosis – a combination of outward and lateral spine curvature towards the upper back
- Rotational scoliosis – a severe form of scoliosis where the spine curves to one side but also curves with a strong degree of rotation
In 8 out of 10 cases there is no known cause; this is known as idiopathic scoliosis where the curvatures of the spine occur in otherwise healthy children and adolescents. The majority of the rest of the cases are caused by medical conditions; non-idiopathic scoliosis is referred to as symptomatic or syndromic scoliosis since its occurrence can be directly attributed to a long term medical condition such as cerebral palsy, muscular dystrophy, Ehlers-Danlos syndrome and Scheuermann’s disease.
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.
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 is based on the patient’s 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 scoliosis bracing with the Gensingen brace (depending upon bone maturity)
- 25+ degrees – effective scoliosis bracing with the Gensingen brace and intensive or advanced self-management of Schroth therapy (specialised physiotherapy)
Our treatment recommendations will be based on the severity of the Cobb angle and the age of the patient. If the Cobb angle is over 25° it is likely that we will recommend a combination of bracing with the Gensingen brace and Schroth therapy.
The LOC Scoliosis Team is headed by Deborah Turnbull (middle) and Sally Hews (right)
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