Introduction
Scoliosis is an abnormal curvature of the spine to one side, with the spine bending either to the left or to the right. The amount of curvature can vary from slight to severe and the curve can be in the shape of a C or S.
The bend can occur at any point along the spine, from the top to the bottom. However, the most common areas to be affected by scoliosis are:
- the chest area (thoracic scoliosis)
- the lower part of the back (lumbar scoliosis)
Scoliosis does not usually cause any noticeable symptoms in children other than affecting the appearance of the back. It’s much more likely to cause symptoms in adults, including back pain and shooting nerve pain caused by the nerves in the spine being compressed. Find out more about symptoms of scoliosis.
Who is affected by scoliosis?
In the past, scoliosis was thought to be a condition that mainly affected children. However, it is now recognised as a condition that increasingly affects older adults. This is most likely due to the increasing age of the population.
In the UK, scoliosis affects three to four children out of every 1,000 and can develop at any time during childhood and adolescence (the teenage years). Scoliosis is more common in girls than boys and often occurs at the start of their adolescence.
It is thought that as many as 7 out of 10 older adults aged 65 or over have some degree of scoliosis.
Many cases result from undiagnosed scoliosis during childhood. Damage to the bones, tissues and joints of the spine can also cause scoliosis. You may hear your doctor refer to this as degenerative scoliosis.
Read more about the causes of scoliosis.
Treating scoliosis
In 90% of cases of childhood scoliosis, treatment is not required because the condition corrects itself as the child grows. Most of the remaining children with scoliosis can be successfully treated using a back brace to prevent the spine from curving further. Very few children (about 1 in 350) will require surgery to correct the position of their spine.
In adults, it is usually too late to correct the position of the spine so treatment aims to relieve the symptoms of pain. Non-surgical options, such as painkillers, exercise and back braces, are the preferred option with surgery being seen as a treatment of last resort.
Read more about treating scoliosis in children.
^^ Back to top
Causes
Children
Idiopathic scoliosis
In about 8 out of 10 cases of scoliosis, the cause is unknown. This is medically known as idiopathic scoliosis.
However, researchers have found that in about a third of idiopathic scoliosis cases, the child has some family history of the condition, which suggests a genetic link to the condition.
Scoliosis is not caused by bad posture, exercise, diet or by wearing backpacks or satchels.
Neuromuscular conditions
Most of the remaining cases of scoliosis are caused by conditions that affect the nerves and muscles (neuromuscular conditions), such as:
- cerebral palsy – a condition that is caused by brain damage that occurs during birth or shortly afterwards
- muscular dystrophy – a genetic condition that causes muscle weakness
Children with these conditions may be unable to walk or have difficulty remaining upright, both of which can prevent their spine from developing normally.
Congenital scoliosis
Scoliosis present at birth is known as congenital scoliosis. Congenital scoliosis is rare and are caused by the bones in the spine developing abnormally in the womb.
Adults
Many cases of adult scoliosis are thought to be milder cases of idiopathic scoliosis that have only become apparent in later life. With age, what was previously a very minor curve to the spine may in later life become more pronounced.
Degenerative scoliosis
Degenerative scoliosis is caused by gradual damage to the various body parts that make up the spine, such as the:
- vertebrae – the ridges of bone that help support the spine and neck
- discs – the spongy sections of tissue that help cushion the vertebrae
- ligaments – the bands of tissue that hold the vertebrae and discs together
- tendons – the bands of tissue that connect the bones in the spine to the muscle
Damage to one or more of these body parts can destabilise the structure of the spine, causing it to curve abnormally. The discs of the spine are known to narrow and weaken with age, which can explain some cases of degenerative scoliosis.
Other possible causes include:
^^ Back to top
Children
Treating scoliosis in children
If your child has scoliosis, the treatment they receive will depend on their age, the extent of the curvature of their spine and how well their lungs work.
There are four treatment options:
- observation
- casting
- bracing
- surgery
The different treatment options are described below.
Observation
Treatment for scoliosis is often unnecessary because most cases are not severe and the condition often corrects itself as the child grows.
However, X-rays are needed every six months so that the progress of the curvature can be carefully monitored.
Casting
In early cases of scoliosis, your young child’s spine may need to be guided back into its normal position as they continue to grow. This can be achieved by using a brace, made out of of plaster of Paris, which is attached to your child’s body.
Your child will have to wear the cast constantly, without removing it. However, it will need to be changed regularly to allow for your child’s growth and development. Due to the specific way that a cast is made, your child should be referred to a scoliosis specialist if a cast is required.
If your child is under the age of two, the cast will be changed under an anaesthetic every two to three months to straighten the spine. However, it is likely that your child may need to use a removable brace after the casting treatment.
Bracing
If the curve of your child's spine is more severe (with an angle of more than 20 degrees), a brace will be required. A brace cannot cure scoliosis or correct the curve, but it can stop the curve from getting worse.
The brace will need to be carefully fitted to your child's spine. To do this, a cast of your child's spine will need to be taken. This can be done on an outpatient basis, which means that your child will not have to stay overnight in hospital. Instead, they will have one or more appointments at a hospital or clinic.
It is usually recommended that the brace is worn for 23 hours a day, and that it is only removed for baths and showers. The brace should not interfere with normal everyday activity and can be worn during most non-contact sports. However, it is recommended that the brace is removed during contact sports.
It is important for children who wear braces to take regular exercise. This will help improve muscle tone and body strength, and will help make wearing the brace more comfortable.
The brace will have to be worn for as long as your child's body is still growing. Boys typically stop growing at around the age of 17 and girls typically stop growing at around the age of 15.
Surgery
If your child's scoliosis is severe (if their spine has a curve of more than 50 degrees), they may require surgery and will be referred to a specialist unit.
Surgery can help prevent damage to the heart and lungs, and can also help to alleviate back pain and the abnormal development of your child's body.
Spinal fusion surgery is a complicated technique where the spine is straightened using metal hooks and rods, before being fused into place using bone grafts. It should only be carried out by experts in this type of surgery.
The surgery will take four to eight hours. After surgery, your child will be transferred to an intensive care unit (ICU), where they will be given intravenous fluid (administered through a vein) and pain relief. Most children are well enough to leave intensive care after 24 hours, although they will often need to spend another 7 to 10 days in hospital.
After the operation, most children can return to school after four to six weeks and can play sports about a year after having surgery. Some children may need a back brace to support their spine, which is usually removed after six months.
After having spinal fusion surgery, your child will need to return to hospital every six months to have the rods lengthened by approximately 1cm to keep up with their growth. This is usually an outpatient procedure that is performed through a small incision (cut). A brace will need to be worn to protect the rods. The rods will be removed during surgery when your child is older and their spine has grown.
Risks of spinal fusion surgery
There are several risks associated with spinal fusion surgery. It will not be recommended for your child unless the surgeon feels the benefits outweigh the risks. It is important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment.
The known risks of spinal fusion surgery are described below:
- Rod displacement. In around 5% of people who have surgery, one of the rods used to straighten the spine will move from its correct position. This should not cause any discomfort, but additional surgery may be required to return the rod to its correct position.
- Pseudarthrosis occurs when one or more of the bones used to fuse the spine into place fails to graft properly. Pseudarthrosis happens in around 1-5% of cases. It can cause mild discomfort and, in some people, can also cause some loss of the correction of the curvature of the spine. Further surgery will be needed to re-graft the relevant bones.
- Infection. Around 1%-2% of people develop an infection after surgery. However, this can usually be easily treated with antibiotics.
- Nerve damage. In very rare cases (in about one or two cases in every 1,000), spinal fusion surgery will cause damage to the nerves in the spine. The results of this nerve damage can be relatively mild (a feeling of numbness in one or both legs), or it can be more severe and cause a loss of all lower bodily functions (paraplegia). To minimise this risk, a neurologist (a specialist in conditions of the nervous system) will be present during spinal fusion surgery to monitor the nerves and prevent any damage to them.
Additional therapies
Several additional therapies may be helpful in correcting scoliosis. These include:
- osteopathy - manipulation of the muscles, nerves and joints
- physiotherapy - massage and manipulation to help improve general health and wellbeing
- reflexology - a therapy where certain areas of the body, such as the soles of the feet, are massaged to help improve general health
- acupuncture - a traditional Chinese treatment that involves sticking needles into certain points of the body to improve health
- electronic stimulation of the nerves in the back
It is important to note that there is little evidence to show that these additional therapies are effective in treating scoliosis. Physiotherapy can be beneficial, but only when it is used in combination with a back brace.
^^ Back to top
Treatment
Treating scoliosis in adults
Medication
In adults, painkilling medication is usually the first recommended treatment option to help relieve the painful symptoms that are associated with scoliosis.
Paracetamol is the painkiller that is usually recommended as the first treatment for acute backache.
If paracetamol is not effective in helping to control your pain, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used.
If you are experiencing nerve pain as a result of your spine compressing or irritating the nerve endings, a nerve block may be recommended. This involves having local anesthetic injected directly into the affected nerves. A nerve block should provide short- to medium-term relief from the nerve pain because the local anesthetic will stop the pain signals that are being transmitted from the nerves reaching your brain.
If it is thought that the weakening of the bones of your spine (osteoporosis) is contributing to your symptoms, you may be given medication and supplements to help strengthen your bones. Find out more about treating osteoporosis.
Exercise
Research has found that regular daily exercises adding up to about 150 minutes a week (2 hours and 30 minutes) can help to improve posture and relieve the symptoms of pain.
A physiotherapist is a healthcare specialist who uses massage and manipulation to help promote health and wellbeing. They will be able to devise an exercise routine for you to help strengthen the muscles around your spine and correct your posture to compensate for the effects of the scoliosis. See Physiotherapy for more information.
Activities that do not place pressure on your spine, such as swimming, may also prove useful.
Braces
In adults, wearing a brace cannot correct your scoliosis but it can provide pain relief. If you find that walking irritates your spine because one leg is longer than the other (due to the curve of your spine), you may benefit by using special shoe inserts called orthotics. Orthotics can help to correct your posture.
Surgery
Due to the relatively high risks associated with spinal surgery, surgery for scoliosis is usually only recommended if:
- You have severe pain that is not responding to non-surgical treatments.
- The curvature of your spine is getting progressively worse and it is thought that it could damage your heart and lungs at some point in the future if left untreated.
Surgical options for scoliosis include:
- decompression – if a disc is pressing down on a nerve, the disc can be removed to reduce the pressure on the nerve
- spinal fusion surgery – where the position of the spine is corrected using metal rods, plates or screws before being fused into place using a graft of either donated bone or artificial materials, such as ceramics
Common complications of spinal surgery include:
- the surgery fails to achieve a significant reduction in symptoms of pain; this occurs in around 30% of adults with scoliosis
- in cases of spinal fusion surgery, sections of the spine may fail to fuse together properly; this occurs in an estimated 5%-10% of cases
Less common complications of spinal surgery include:
- infection – which occurs in an estimated 1 in 50 cases
- blood clots – which occur in an estimated 1 in 100 cases
- retrograde ejaculation – where sperm travels backwards into the bladder when you ejaculate rather than out of your penis; this happens as a result of nerve damage and occurs in an estimated 1 in 100 cases
More serious nerve damage can result in the loss of bladder or bowel function and cause urinary and bowel incontinence. However, this type of complication is very rare.
^^ Back to top