Dr. Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes
Scoliosis causes the spine to curve to one side. The curvature can be in any part of the spine but usually affects the upper spine and lower back. Depending on the degree of curvature, a person may need to wear a brace. Surgery is sometimes necessary. Scoliosis is most common in the later stages of childhood or the early teenage years when the person is still growing fast. It is more common in females than in males. Scoliosis is not always noticeable, but some people with this condition may lean to one side or have uneven shoulders or hips due to the curve of the spine.
In most cases, the person does not need treatment because the curve often does not progress a significant amount. However, depending on the degree of curvature and the age of the child, doctors may recommend a combination of back bracing and physical therapy. A very small number of people with scoliosis may need surgery. Possible complications of scoliosis include chronic pain, breathing difficulties, and a reduced capacity for exercise.
A person with scoliosis will have a sideways C- or S-shaped curve in their spine. For a doctor to diagnose scoliosis, the Cobb angle measures the curvature — must be at least 10 degrees.
Scoliosis can appear at any age, but it often presents between the ages of 10 and 12 years or during a person’s teens. While scoliosis is rare in infants, infantile scoliosis can affect people before the age of 3 years.
In most cases, there is no known cause of scoliosis. Doctors call this idiopathic scoliosis. In other cases, scoliosis may have an association with cerebral palsy, muscular dystrophy, or spina bifida. Alternatively, it may be a birth abnormality. Doctors will classify spinal curves as structural or nonstructural. A structural curve is permanent and may be due to a medical condition or injury. A nonstructural curve is temporary, meaning that the spine is structurally normal. In either case, a doctor will try to find and correct or treat the cause.
RISK FACTORS
• Age: Signs and symptoms often start during a growth spurt just before puberty.
• Gender: Females have a higher risk of scoliosis than males.
• Genetics: People with scoliosis often have a close relative with the condition.
TYPES
• Congenital scoliosis
• Early onset scoliosis
• Adolescent idiopathic scoliosis
• Degenerative scoliosis
• Neuromuscular scoliosis
• Scheuermann’s kyphosis
• Syndromic scoliosis
CAUSES
Below are some of the possible causes of scoliosis:
• Neuromuscular conditions: These conditions affect the nerves and muscles. They include cerebral palsy, poliomyelitis, and muscular dystrophy.
• Congenital scoliosis: Congenital means that the condition was present at birth. Scoliosis is rare at birth, but it can occur if the bones in the spine develop abnormally when the fetus is growing.
• Specific genes: Researchers believe that at least one gene plays a role in the development of scoliosis.
• Leg length: If one leg is longer than the other, an individual may develop scoliosis.
• Syndromic scoliosis: Scoliosis can develop as part of a medical condition, including neurofibromatosis or Marfan’s syndrome.
• Osteoporosis: Osteoporosis can cause secondary scoliosis due to bone degeneration.
• Other causes: Poor posture, carrying backpacks or satchels, connective tissue disorders, and some injuries can cause spinal curvature.
SYMPTOMS
Scoliosis usually becomes apparent from infancy or adolescence. The symptoms differ depending on the person’s age.
• Symptoms in adolescents
The most common form of scoliosis appears in adolescence and is known as adolescent idiopathic scoliosis. It can affect people between 10 and 18 years of age. Symptoms can include the following:
• Head may appear a bit off center
• Ribs on each side may be slightly different heights
• Hip may be more prominent than the other
• Clothes may not hang evenly
• Shoulder or shoulder blade may be higher than the other
• Person may lean to one side
• Legs may be slightly different lengths
Some types of scoliosis can cause back pain, but it is not usually very painful. This symptom is more common in older adults.
• Symptoms in infants
In infants, symptoms can include:
• Bulge on one side of the chest
• Consistently lying with the body curved to one side
• In severe cases, problems with the heart and lungs leading to shortness of breath and chest pain
If an infant does not receive treatment for scoliosis, they will be more at risk of problems later in life, such as impaired heart and lung function.
DIAGNOSIS
A doctor will carry out a physical examination of the spine, ribs, hips, and shoulders. With the aid of a tool called an inclinometer, or scoliometer, the doctor can measure the degree of scoliosis. An angle greater than 10 degrees indicates scoliosis.
• Imaging scans such as X-rays, CT scans, and MRI scans can help the doctor assess the shape, direction, location, and angle of the curve.
• The doctor may refer the person to an orthopedic specialist for further advice.
TREATMENT
In most cases, childhood and adolescent scoliosis is mild and does not need treatment. With a curve of 10 to 25 degrees, a doctor will usually have checkups with the person at 3-, 6- or 12-month intervals to check whether the condition is changing.
• For a 25-to-40-degree curve, a doctor may recommend bracing. If the curve is greater than this, and the skeleton is still immature, a doctor may recommend surgery.
The doctor will consider the following factors when deciding on treatment options:
• Sex: Females are more likely than males to have scoliosis that gradually gets worse.
• Severity of the curve: The type and severity of the curve may affect how it progresses. S-shaped curves are typical of those with idiopathic scoliosis, whereas C-shaped curves are more common among those with neuromuscular scoliosis.
• Curve position: A curve in the center part of the spine is more likely to get worse than a curve in the lower or upper section.
• Bone maturity: The risk of worsening is lower if the person’s bones have stopped growing. Braces are more effective while the bones are still growing.
Casting
In infantile scoliosis, a doctor may use plaster casting instead of bracing to help the infant’s spine grow into a typical position. The cast attaches to the outside of the infant’s body, and they will always wear it. As most infants grow rapidly, the doctor will need to change the cast regularly.
Bracing
If a person has moderate scoliosis, and the bones are still growing, the doctor may recommend a brace. The brace will prevent further curvature, but it will not cure or reverse scoliosis. The person will usually need to wear braces all the time, even at night. Its effectiveness tends to correlate with the number of hours per day that the person wears the brace.
Chiropractic treatment
Some people visit a chiropractor to relieve the pain and discomfort of scoliosis. Chiropractors manipulate the spine and provide alternative treatments. They maintain that realigning the spine will promote healing and well-being.
Exercises
Various exercises may help with scoliosis, and experts propose a range of strategies. However, they all aim to realign the spine, rib cage, shoulders, and pelvis to achieve a typical posture. The authors of a 2016 study stated that there is growing evidence to suggest that exercises can help treat scoliosis. However, they noted that researchers need to do more studies to work out which exercises are most effective.
• In severe cases, scoliosis can progress over time. In these cases, a doctor may recommend spinal fusion. This surgery reduces the curvature of the spine and prevents scoliosis from getting worse.
• A surgeon may use metal rods, hooks, screws, or wires to hold a part of the spine straight while the bone heals. They may also use bone grafts to help the bone heal.
Children can usually go back to school after 4–6 weeks and can take part in sports after between 3 and 6 months. They should avoid sports that jar the back, such as horse riding and contact sports, for a year. In some cases, they may need to wear back brace for about 6 months to support the spine.
