What is scoliosis?
When viewed from the front or the back the spine is usually completely straight. The trunk is usually fairly symmetrical and the pelvis bones are level. From the side, there are gentle curves making a S shape to your spine.
A scoliosis means that the spine is curved abnormally when viewed from the front or the back. It can lead to the trunk and shoulders no longer being symmetrical. Sometimes the shoulders aren’t level anymore. Sometimes the head is not level or the pelvis is not level. The rib cage can also push out on one side so that it becomes prominent - this is known as a rib hump. The severity of the abnormalities can vary between people and can change with time.
How would I know I had scoliosis?
Either you or someone else may notice that you are not standing straight or that you have changes in the shape of your spine.
You may notice:
- Rib cage sticking out on one side especially at the back
- Shoulders not being level
- Your hip or waist sticking out
- Your head tilting over to one side of your trunk
- Clothes not fitting well anymore
- Not being able to stand up straight
- You may have pain as well as the changes above
Courtesy of SRS
Why does it matter?
It is important for a specialist to assess your scoliosis to decide if it is a problem or may become a problem. Often, it will be a matter of some simple investigations and then monitoring over time. In the majority, nothing more than observation is required and you can live a normal life with a scoliosis. If and when problems arise, the specialist can discuss these with you and help manage them.
Sometimes the shape changes can make you feel very awkward and worried about your appearance. Some people do get very embarrassed about their shape, this is not unusual. The shape can change as you grow, particularly at the time of growth spurts.
If scoliosis worsens, it can affect the mechanics of your spine and result in aching or pain.
Occasionally, especially if the scoliosis affects you early in life, it can affect the development and function of your lungs. This does need to be treated or at least monitored. Thankfully, this is not common.
Scoliosis that has started as a child or teenager can go on to have wear and tear changes later in life resulting in pain or nerve pressure.
Scoliosis that starts later in life is usually because of wear and tear and often can cause pain and nerve pressure.
What causes scoliosis?
There are many different causes for scoliosis which gives us the different scoliosis types. One of the jobs for the specialist will be to check on what might be causing your scoliosis.
The commonest scoliosis types are:
In children and teenagers there is often no obvious reason why the scoliosis has happened. This is known as idiopathic scoliosis. It may be genetic, but we do not know for sure.
Idiopathic scoliosis that starts before the age of 10 years old is called early onset idiopathic scoliosis.
Idiopathic scoliosis that starts after 10 years of age is called late onset or adolescent idiopathic scoliosis.
People with problems with their nervous system (brain or spinal cord) or muscles can get a scoliosis that we call neuromuscular scoliosis. For example this type of scoliosis can occur in cerebral palsy or muscular dystrophy.
You can be born with a scoliosis due to abnormally shaped or abnormally developed bones in the spine. This is called a congenital scoliosis.
- Adult degenerative scoliosis
Scoliosis can first affect you in adulthood. This could be because there was always a childhood scoliosis which starts to cause symptoms as your spine ages.
Alternatively, in adulthood you can develop a new scoliosis due to degenerative (wear and tear) processes. This is called de novo or adult degenerative scoliosis.
There are rarer causes for scoliosis. For example, neurofibromatosis, Marfan’s syndrome, enzyme storage disorders and genetic defects can all be associated with scoliosis. Sometimes infections or fracture can cause a curvature.
What should I do if I think I have a scoliosis?
Speak to your GP. Your GP will be able to examine you to see if there is a scoliosis.
If your GP is concerned, they will refer you to a spine surgeon, paediatrician or orthopaedic surgeon at a hospital for further tests.
Once a scoliosis is confirmed, it is usually the Spine Surgeon at a recognised spine centre that will assess you fully and talk about what you may need. The GP, Paediatrician or Orthopaedic Surgeon will refer you on to the Spine Surgeon.
Do not ignore it if you think you have a scoliosis. More often than not, it will be nothing serious and just require monitoring at the hospital. However it is important to be sure and so having someone check you properly is important.
If you have no pain, you can usually carry on with your normal activities, including sports. If you have pain, it might be better to stop sports until you are seen.
How will the doctors check if I have a scoliosis?
The first thing the GP or specialist will do is talk to you about your concerns. They will ask you questions about your health generally, how the problems are affecting you and try to get an idea how much more growth and development you have if you are not fully grown yet.
The doctors will want to examine you. They will need to examine your back, your arms and your legs, so you will need to get undressed for this. Often the hospital will give you a gown, but wearing shorts and a T shirt or sports bra may make you feel more comfortable. The examination will look at your back and see how flexible it is. They will look at your back whilst you are bent forwards as this reveals the scoliosis more (Adam’s position). Your arms and or legs will be examined to make sure the spinal cord is working normally.
The Spine Surgeon will send you for X - rays. These are necessary to see if there is a scoliosis and how bad it is. The Spine Surgeon will measure the angle of the scoliosis on the X - ray (Cobb angle).
After all of this, the doctors may want you to go for further tests such as an MRI scan or surface topography (a way of mapping the contours of your spine).
If the plan is to monitor your scoliosis, you will be asked to return in a few months (often 6-9 months) for another examination and X - ray.
How can you treat scoliosis?
Different types of scoliosis need different treatments. See the individual types for more detail. In general the management will be:
The vast majority of scoliosis only needs to be monitored with X - rays and a clinic review. How long you are monitored for will depend on your age and whether the scoliosis is bothering you.
In almost all cases of scoliosis, continuing with your normal activities including sport and exercise is allowed. In fact, staying fit and active is going to be good for you and your scoliosis. As yet there is no evidence that exercise alone can treat a scoliosis, but there is more research into this area.
Some types of scoliosis may need a brace at some stage. The braces are usually rigid and need to be worn almost full time to have an effect. Your specialist will discuss the type of brace required and how long for with you.
In general surgery is only required if your scoliosis is causing you problems or is at risk of causing problems in the future. Most people with scoliosis do not have to have surgery.
If surgery is necessary the team looking after you will balance the risks and benefits before offering you surgery. They will discuss those risks with you to help you make a decision about going ahead with surgery. The hospital you have your surgery in should have all the facilities required to keep you safe and make sure the operation and progress after the operation goes well.
Some of those facilities include having the right anaesthetic team for the operation. During the operation the anaesthetist will look after you by using a lot of monitors and medication. They will help control your pain after the operation.
In the operation, the use of intraoperative spinal cord monitoring (IOM) is mandatory in the UK. This means that electrodes are used on your scalp and limbs when you are asleep to keep an eye on the function of the spinal cord. This acts as a warning system during the operation and so reduces the risk of a spinal cord injury (resulting in numbness or weakness) during the operation.
After the operation, you may need to be looked after in a High Dependency or Intensive Care ward for a while. This is to make sure you are kept a close eye on and reduce the risks of complications after the operation.
Your time in hospital will vary and this will be discussed with you. As you can expect, you will have to reduce activities for a while to recuperate after surgery. The time required will vary depending on the operation you have had.
Want to know more?
To find out more about the different types of scoliosis click on the one you are interested in.