Scoliosis is when the spine curves from side to side. It can happen at any time during a child’s growth. As the spinal column curves, it twists rotating the ribcage as it does so, leading to changes which can be seen in the spine and the chest and at the level of the pelvis/hips.
What causes scoliosis?
In 80 per cent of cases, the cause is idiopathic (unknown).
Abnormal development of the bones in the spine can cause congenital (present at birth) scoliosis.
A variety of conditions that affect how the nerves and the muscles work, for example
cerebral palsy or muscular dystrophy, can cause neuromuscular scoliosis.
The way the scoliosis shows itself, its management and the prognosis vary considerably depending on the underlying cause of the curve.
What are the signs and symptoms of scoliosis?
Children with scoliosis may have one or more of the following signs and symptoms:
- one shoulder is higher than the other
- one shoulder blade is more prominent than the other
- one side of the rib cage is more prominent than the other
- one hip (or one side of the pelvis) is higher than the other, making the waistline appear uneven
- clothes do not hang properly
If the child is in a wheelchair they may lean heavily to one side making seating more difficult.
How is scoliosis normally diagnosed?
A GP or nurse can diagnose a scoliosis by looking at the spine, ribs, hips and shoulders.
After that, an orthopaedic specialist will take an x-ray to confirm the diagnosis. The x-ray images will also help to identify the location, direction and severity of the curve. The angle made by the curve is measured: it is called the Cobb angle.
If the spinal curvature is severe, the symptoms of scoliosis are unusual (for example, if the child has back pain or new neurological findings) or if surgery is contemplated, a
magnetic resonance scan or image (MRI) may be recommended.
MRI scans use a magnetic field and radio waves to build up a picture of the inside of the body. The MRI scans can detect some (but not all) underlying neurological conditions (conditions that affect the nerves and muscles).
How is scoliosis normally treated?
The aim of treatment is to stop the curve progressing and/or improve the curve. The choice of treatment depends on the child’s age, the severity and type of the curve and the underlying diagnosis, if known.
There are three types of treatment:
- observation
- bracing
- surgery
The spinal surgeon will discuss the treatment options for the child with their parents.
Observation is often the only treatment needed, as most curves do not become severe. A series of x-rays will be taken each time the child comes for an outpatient appointment and the surgeon will compare these with previous x-rays to see if the curve (measured by the Cobb angle) has progressed.
Bracing is needed if the curve is of moderate severity and/or is progressive. It may help reduce further curvature. A plaster cast of the child’s torso will be taken during an outpatient appointment so that the brace can be custom-made for the child. Braces should be worn for 23 hours each day, removed only for personal hygiene and activities such as swimming or PE.
Surgical treatment may be needed for severe or progressive curvatures. There are two main approaches to spinal surgery: anterior or posterior.
Surgical treatment
The anterior surgical approach is via an incision (cut) through the side of the chest wall along the line of a rib. The posterior approach is through an incision directly over the ‘lumpy’ part of the spine in the middle of the back. One or both of these approaches may be needed. The surgery may be done in one or two stages, and on average will take between three and six hours.
The joints linking the bones of the spine together in the affected part are first of all freed up so that the curve straightens and then the bones are held in their straightened position by a system of metal rods and/or screws that fix into the bones until the bones fuse together themselves.
Fused bones can not move or bend again. They also can not grow, so if the surgery is done very early, the child will not grow as much as they should. So, in younger children, a growth rod is often inserted to allow the spine to grow as the child grows.
A series of minor operations are needed to allow growth by lengthening the rod. A magnetic system is being developed which might make this process a lot easier. When the child has grown enough, they will have a ‘definitive’ spinal fusion operation.
What happens next?
Children with scoliosis often grow up without significant restrictions and they can and do lead a normal life.
