Scoliosis is an abnormal curvature of the spine. The spine bends to one side of the body, causing the torso to compress on that side. The ribs on that side will be closer together while the ribs of the other side will be farther apart. Scoliosis also involves a rotation of the spine, in which the individual vertebrae bones twist around the long axis of the spine.
It's estimated that 2% to 4% of all children ages 10 to 16 have detectable scoliosis. An equal number of boys and girls develop scoliosis. When boys are affected, it usually develops in early childhood.
Most people with scoliosis have barely noticeable curvatures; however, girls are more likely to develop scoliosis bad enough to need treatment.
Although the exact cause of scoliosis is unknown, genetics is believed to play a role, as it often runs in families. When scoliosis develops later in childhood, there's usually no cause found in over 80% of cases – the rest can be due to conditions such as polio, cerebral palsy, juvenile osteoporosis, or other disease. This condition is also associated with poor posture; in fact, scoliosis is the cause of poor posture in many cases.
Adults may develop functional scoliosis in the presence of severe muscle spasm caused by muscle strain, other injury, or degeneration of the spine. In the case of muscle spasms or strains, scoliosis resolves with treatment of the underlying problem.
Symptoms and Complications
Although the spine's curvature is unnaturally bent in individuals with scoliosis, there are usually no symptoms. Some people may experience vague muscle back pain, stiffness, or fatigue. Most curves are convex to the right in the upper back and to the left in the lower back, so that the right shoulder is higher than the left one. One hip may also be higher than the other. A parent or friend may notice that the spine appears curved, and the ribs on one side of the body will appear closer together compared to the other side.
Developing scoliosis may go undetected for years until a child reaches adolescence. As the child enters puberty, and is growing more quickly, the degree of spinal bending can dramatically increase and become very noticeable.
There are different degrees of scoliosis. Very mild scoliosis usually doesn't require any treatment other than regular follow-up with a doctor since it generally doesn't cause any symptoms. For those with more severe scoliosis, back muscle fatigue and pain may be felt during prolonged periods of standing or sitting.
In some people, the condition can progress and worsen with time. The abnormal compression of the ribs on one side of the body can put pressure on vital organs and can cause a change in function of the heart and lungs if left untreated.
Making the Diagnosis
Mild scoliosis may be detected during a routine physical examination. Usually a doctor may suspect scoliosis when a child has one shoulder that seems higher than the other or when clothes don't seem to "hang right" on a child. In most cases, the doctor will be able to diagnose scoliosis based on a simple, forward-bending test.
The doctor will examine the levels of the shoulders and shoulder blades and the curve of the ribs as the child or adolescent bends slowly forward. A greater dip in one shoulder usually is a sign of scoliosis. Ribs may be curved differently from one side to the other. X-rays aren't always necessary but may be used to determine the severity of the spine's curvature.
Treatment and Prevention
Treatment will be based on the severity of the spine's curvature. In mild cases, treatment isn't necessary. The more severe the curve, the greater the chances that the condition will progress. About 50% of children with scoliosis will need some form of treatment or at least require close follow-up with a doctor. Prompt treatment will usually prevent the condition from worsening.
For progressive scoliosis, a customized brace or plaster cast will be needed to hold the spine straight. The brace is made to extend from the hips to the neck and must be worn for about 23 hours a day. The brace is worn until the skeleton stops growing rapidly, which is usually when adolescents have almost reached full height.
For many young patients, wearing a brace to school can be very stressful and frustrating. Counselling and support can help children and adolescents adjust and deal with negative feelings and concerns. Without the help of the brace (and sometimes despite brace use), the scoliosis can get worse and surgery may be required. In very severe cases, surgical correction of the spine may be necessary and most commonly involves a spinal fusion with attachment of metal rods to the spine. In the majority of cases, a back brace or surgery helps correct the problem.
Another treatment sometimes used is electrospinal stimulation. In this procedure, the spinal muscles are stimulated with tiny electrical currents and strengthened, and this may help straighten out the spine.
A family history of scoliosis is an important risk factor. If you have a family history of scoliosis, take your child to see your family doctor or a pediatrician for early screening. Learn about exercises that can improve posture and strengthen the muscles that support the spine (e.g., abdominal muscles). When detected early and treated appropriately, scoliosis may not progress or cause major disability.