What is scoliosis?

Scoliosis is an abnormal curvature of the spine. It is a common condition affecting about 2-3% of the population to some degree. About 10% of those affected have a minor form of the condition and about one in 1000 people have severe scoliosis. [1]

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Causes

In most cases, the cause of scoliosis is unknown, but it appears to be hereditary and passed down through generations. In some cases, having legs of different lengths can cause a tilting of the hips and to compensate, your body tilts your shoulders the other way. In some rare cases, neuromuscular conditions, such as cerebral palsy, can cause muscle spasms that alter the alignment of the spine. Birth defects or injuries to the spine can also cause scoliosis.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Risk factors

Risk factors associated with developing scoliosis include:

  • Age - scoliosis symptoms usually appear just before puberty (11-13 years old);
  • Gender - although males and females are affected equally, females are more likely to progress to severe scoliosis and more likely to require treatment, and;
  • Family history.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Types

There are four main types of scoliosis:

  • Idiopathic adolescent scoliosis - this is the most common type, accounting for four out of five cases. It most commonly occurs around 11-13 years of age, or during a growth spurt;
  • Infantile idiopathic scoliosis - this more commonly affects boys and often develops before the child is three years old. This can often spontaneously resolve as the child grows older;
  • Juvenile idiopathic scoliosis - this more commonly affects girls and usually occurs between the age of 3-10 years, and;
  • Progressive scoliosis - involves a worsening of the condition over time. This can lead to severe scoliosis and is more common in females.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Signs and symptoms

Signs and symptoms of scoliosis can vary in degree from mild, moderate to severe. These can include:

  • A sideways lean;
  • Poorly-fitting clothes;
  • Tilted waist;
  • One hip higher than the other;
  • Uneven shoulders;
  • Protruding ribs or shoulder blades, and;
  • A pronounced curve when bending forward.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Methods for diagnosis

To identify scoliosis, the 'forward bend test' can be used. This involves bending forward at the waist while the doctor stands back to diagnose an abnormal curvature of your body or spine. An X-ray of the spine can also be used to demonstrate and assess the severity of the scoliosis. 

Scoliosis forward bend test.Scoliosis can be identified by the 'forward bend test'. 

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Types of treatment

Depending on the degree of curvature of the spine, various treatments can be used. A minor condition can be helped by physiotherapy and practising good posture. For more severe conditions, the following treatments can be used:

Brace

A custom-made brace to fit under clothing can be used if you have moderate scoliosis. This is commonly used before adolescence and can help to straighten the spine during this period of growth. If most growing has already occurred, a brace can also be used to prevent the curvature from becoming worse.

Surgery

In more severe cases of scoliosis, surgery may be required. This is performed in a process called spinal fusion and usually done after a child has stopped growing. This involves correcting the curvature then fixing it in place, by joining the vertebrae together using extra bone, often taken from the pelvis. Rods, wires, hooks and screws can also be used to hold the vertebrae stable while they fuse together.

Physiotherapy

A healthcare profession that treats bodily weaknesses or defects with physical remedies, such as massage or exercise.

Vertebrae

The bones that make up the spinal column.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Potential complications

In most cases, scoliosis is mild and does not require treatment. In more severe cases, complications can occur, which include:

Ongoing back problems

People with scoliosis can experience back pain, which can be persistent and severe in certain cases.

Heart and lung damage

Scoliosis can cause injury to the heart and lungs. This is caused by increased pressure on the rib cage and can lead to breathing difficulties. There is also a risk of pneumonia and other chest infections.

Physical disability

In severe cases, an unfortunate complication can be the visual appearance of the condition. This can lead to social embarrassment, may prevent work opportunities and can impair quality of life.

There can also be problems with pregnancy due to the extra weight of carrying a baby, which puts added strain on the spine. There is also a risk of osteoporosis later in life.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Prognosis

In many cases, scoliosis appears in only a minor form. In the most severe cases, surgery is an option, which can halt and, occasionally, reverse the condition.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.

Prevention

As the cause of scoliosis is largely unknown, there is no particular way to prevent it. It is important to identify any abnormal curvature at an early age. Early intervention can help lessen the severity of the condition if physiotherapy, good posture practice or a brace are used.

Physiotherapy

A healthcare profession that treats bodily weaknesses or defects with physical remedies, such as massage or exercise.

1. Murtagh J. MD. (2012) John Murtagh’s Patient Education (6th rRevised edition). North Ryde N.S.W.: McGraw-Hill Australia Pty Ltd.