What is Scoliosis?

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.

Since LOC opened its Scoliosis clinic in 2017 we have treated a broad age range of patients from 3-year-olds to 80-year-olds. Even those with severe scoliosis where the Cobb angle is in excess of 40 degrees have responded well to the combination of bracing with the Gensingen brace and a physiotherapy programme that follows the principles of Schroth Best Practice.

Scoliosis Treatment

Scoliosis can be treated surgically and non-surgically depending on factors such as age and the severity of the curve.

At LOC, we have pioneered non-surgical treatment through back bracing & specialist physiotherapy since spinal surgery is extremely invasive and can lead to complications.

Gensingen Brace

The Gensingen Brace by Dr Weiss® is the first orthotic treatment for scoliosis that is evidence-based.

It is now recommended by scoliosis clinics around the world as the preferred alternative to surgery since it has been proven to reduce Cobb angles and improve posture.

Schroth Method

Our bracing treatment can be combined with a comprehensive physiotherapy programme that adheres to the world-renowned Schroth Best Practice

Our treatment package price includes all reviews and on-site adjustments of the brace by our certified orthotists.

Delayed Surgery Brace

There may currently be cancellations or delays to your child’s spinal surgery for several reasons.

At LOC, we are here to assist where possible. We remain open in a COVID safe environment. Using our corrective bracing, we can halt progression of the curve, balance posture & reduce any back pain.

Types of Scoliosis

The 3 age-related groups for scoliosis are juvenile, adolescent and adult.

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 the Gensingen brace & Schroth therapy.

Treating Kyphosis

A normal back has a 20° to 45° curvature in the upper part of the back, yet anything above 45° is called kyphosis.

Kyphosis causes pain if excessive or if in the wrong place such as the lower back. Our bespoke physiotherapy programme can improve muscle lengths & spinal extensor strength, reducing postural pain.

Scoliosis occurs within different age groups:

  • Infantile scoliosis occurs before the age of three, it is more prevalent 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 scoliosis is more prevalent in girls between the age of 3 and 10; there is 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

GENSINGEN BRACES

VISUAL SIGNS

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 moment you may find it difficult to get a referral to your local hospital, we can provide clinical assessments and refer your child for any necessary back x-rays or scans required. These scans will help us determine the progression factor. This is the incidence of progression according to the formula by Lonstein and Carlson (see graph); this considers the severity of the curve and the skeletal maturity of the patient.

According to Dr Weiss monitoring and observation is indicated when the risk of progression is less than 40%. Specialist Schroth physiotherapy is indicated when the risk of progression is 40-60% and bracing is indicated when the risk is over 60%.

A patient’s treatment can involve one or all of these elements: observation, physiotherapy and bracing. The correct prescription and combination of these elements will be determined by one of our team of specialist scoliosis clinicians. At the patient’s initial consultation, the clinician will look at posture, the exact nature of the curve and its flexibility and also assess the pain associated with the condition. The skeletal maturity and age of the individual will also affect the recommended treatment plan, as described above.

Scoliosis can progress quickly when the skeleton is still growing or during hormonal changes so if you are concerned about your child contact us.

References:

  • Longstein JE,Carlson JM.The prediction of curve progression in untreated idiopathic scoliosis during growth.J Bone Joint Surg Am.1984;66(7):1061-1071
  • Weiss HR.Physical therapy intervention studies on idiopathic scoliosis – review with the focus on inclusion.criteria1.Scoliosis.2012;7(1):4.

Assessment

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.

Our treatment recommendations will be based on the severity of the Cobb angle and the age of the patient. This allows us to calculate the risk of progression and determine the most appropriate conservative management for each patient. We also factor in the individual’s lifestyle and symptoms.

 

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 the maturity of the bones)
  • 20-25 degrees – closely monitor and provide the 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)

Robotic Technology at LOC

Victor the Robot, our new Computer Numerical Control milling machine, in action! Victor is noisy, but he’s transforming our ability to design and manufacture orthotic devices at our Kingston-upon-Thames clinic. 

Manufactured by Rodin4D, Victor is capable of milling complex ergonomic shapes, meaning that we can now potentially assess a spinal orthotic patient, manufacture the orthosis and have it fitted, all in the space of a day. Victor can do everything we need to do for our patients, in-house and in the shortest time possible with no compromise on quality.

Learn more about Victor

PATIENT STORIES

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