Children with cerebral palsy are prone to developing scoliosis as muscle weakness and balance issues are frequently associated with the disorder. Roughly 20% of children who have cerebral palsy will develop scoliosis; the likelihood increases the more severe the cerebral palsy is.
Muscular dystrophy is a group of rare diseases that cause muscles to weaken and deteriorate. As muscles weaken in the back and chest most children with the condition develop curvature of the spine. There are nine major types of muscular dystrophy, the two most common are Duchenne muscular dystrophy and Becker muscular dystrophy. Both of these affects boys almost exclusively. The disorder passes from a mother (who has no symptoms) to her son.
People with Ehlers-Danlos syndrome have abnormalities in the synthesis, processing and structure of collagen which is one of the most important structural proteins in the human body. Kyphoscoliosis, which is a combination of scoliosis and kyphosis, is associated with EDS type V1.
Marfan’s syndrome occurs as a result of a genetic mutation in the chromosome responsible for collagen cross-linking. About 60% of children with Marfan’s syndrome also have scoliosis. Most of the spinal curves associated with Marfan’s syndrome are small and do not require treatment.
Osteopenia is a condition where the bones in our bodies lose some of their density. This often occurs naturally as part of the ageing process and is most common amongst post-menopausal women. Many people with the condition will not be aware they have it. Osteopenia is really just a milder form of Osteoporosis. The connection to adult scoliosis is that a spine that has been weakened is more likely to curve over time so osteopenia and osteoporosis patients are more likely to develop scoliosis than people with a normal bone density.
Hypermobility Syndrome is a condition where a person’s joints move beyond the normal range of motion. It is estimated that 10-15% of normal children have hypermobile joints. The condition itself is considered benign although people with hypermobile joints are susceptible to injury. And it has been found that joint hypermobility is significantly more common amongst juvenile idiopathic scoliosis patients than amongst other children.
Neurofibromatosis is a genetic disorder characterised by tumours or neurofibromas that develop in the nervous system and under the skin. There are two distinct types which are referred to as NF1 and NF2. NFI is more commonly occurring in 1 in 3,000 births while NF2 affects roughly 1 in 25,000. NF2 is associated with tumours that specifically affect hearing and balance and thus have no association with scoliosis. However, about 10% of children with NF1 are also affected by scoliosis; this seems to happen because when tumours have grown on the spinal cord muscle tone can be affected and the spine is, therefore, more susceptible to curvature.
Syringomyelia occurs when a cavity(or syrinx) is formed inside the spinal cord from a build-up of fluid. Syringomyelia can cause stretching of nerve fibres and if untreated will cause permanent damage to them. The only effective treatment is surgery. Scoliosis is also common amongst those with Syringomyelia. According to some studies over 50% of those with Syringomyelia will also develop scoliosis, the incidence is highest amongst sufferers under the age of 16.
The patient’s scoliosis can be treated conservatively after the patient has undergone surgery for Syringomyelia.
Scheuermann’s disease is a condition in which the anterior sections of the spinal vertebrae grow more slowly than the posterior sections during childhood. As a result, the spine develops a forward angle as it grows – this kind of spinal curve is called hyperkyphosis and usually appears in adolescents when they are around 10-16 years of age. They can also develop a secondary hyperlordosis in the lower lumbar section.
Although each patient’s individual condition needs to be thoroughly investigated at the initial consultation, unless there are contra-indications, the primary recommended treatment is a conservative one, combining brace treatment – with our bespoke version of the Cheneau brace – and a comprehensive physiotherapy programme that adheres to Schroth principles.
The exceptions to this general rule are where the scoliosis is a result of Muscular Dystrophy or Scheuermann’s disease where a different type of brace may be recommended.
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