Scoliosis or kyphoscoliosis is an abnormal curvature of the spine where it either curves abnormally to the left or right. With scoliosis the spine can curve with varying degrees of severity at the top or the bottom in any place of the spine. When scoliosis affects the chest it is referred to as thoratic scoliosis and when it affects the lower back it is referred to as lumbar scoliosis. The thoratic and lumber regions are the most likely to be affected as they are most common in cases of scoliosis.Scoliosis is currently affecting a small minority of children in the UK, around four in every thousand. A large majority of these cases of childhood scoliosis is self correcting during growth and maturity therefore not requiring any medical treatment. The small minority of scoliosis children who do require treatment will initially require to wear a back brace and 0.3% of these children will eventually require treatment from surgery.
The cause of scoliosis is rarely identified and this is referred to as idiopathic scoliosis and it is believed that idiopathic scoliosis runs in families. Modern research is revealing the possibilities of a genetic link, making some people more at risk from idiopathic scoliosis. Neuromuscular conditions which affect the muscles and nerves are said to be the main identifiable cause of scoliosis. Neuromuscular conditions like muscular dystrophy or cerebral palsy restrict the childs walking and standing reflexes and therefore the spin does not develop normally. Children with rare birth defects have malformations in their spine during birth.
Scoliosis is far more common in girls rather than boys and onset can begin at any time between childhood and puberty. Although often self correcting during growth in childhood if scoliosis is left untreated then the curvature of the spine can increase in severity and result in damaging the organs such as lungs, heart and formation of the pelvis, chest and the spine itself. It is a common mistake to think that scoliosis can be brought on in life by carrying heavy things, poor exercise or nutrition or even by having a bad posture.
Signs and Symptoms of scoliosis
- Shoulders varying in height in comparison
- Shoulder blades varying in height in comparison
- Hips prominent in comparison
- Badly fitting clothing (said to be hanging loosely)
- Posture leaning to one side
Scoliosis is commonly discovered by your childs own GP or professionals in the education setting and diagnosis of scoliosis is based on a thorough examination of the childs spine, shoulders, chest and ribs. Referrals will then be made to an orthopaedic doctor who will examine again and x-ray, both to look at the severity of the curvatiure of the spine and to make certain of the diagnosis. A magnetic resonance imaging (MRI) scan may be necessary if the scoliosis is so severe that it is causing discomfort in the lower back. Sound waves will help to establish images, but ultimately will check for neurological conditions which could be the cause of the scoliosis. There are currently three types of treatment (observations, Bracing and Surgery) for scoliosis at present and all depend on the severity of the spinal curvature.
Treatment for Scoliosis
Treatment based on observations are mainly for the children who have childhood scoliosis that is self correcting during their growth, hence not requiring braces or surgery, but do bear in mind that x-rays still need to happen twice annually.
Treatment based on bracing is usually in the form of The Boston Brace and is for the children who have the scoliosis spine curvature at an angle of up to 25 degrees. A cast of the spine is necessary in order to make the brace fit correctly. Do not be mistaken by thinking that the fitted brace will cure scoliosis because it will not, instead the brace prevents the scoliosis from becoming more severe. The Boston brace is a lightweight brace that is easily fitted to the spine and can be worn underneath ordinary clothing. Once the Boston brace is fitted it needs to remain in place for a full 23 hours and removal is only permitted for bathing. Regular exercising whilst wearing the Boston brace is recommended as muscle and strength will need some attention. Boys in general need to wear the Boston brace until around 17 years of age and girls at 15 years of age. These ages are the norm when your child will stop growing.
Treatment based on surgery is for the most severe cases of scoliosis, where the scoliosis spinal curvature is more than 50 degrees. The main aim of surgery to severe scoliosis is to limit the damage caused to the organs (heart and Lungs) and relieve the excruciating lower back pains. The surgery itself is extremely difficult and is often referred to as spinal fusion surgery which takes place at a specialist unit where the surgeons specialise in spinal surgery. Metal rods and hooks are inserted and fused into the spine to straighten the scoliosis spinal curvature. This spinal fusion surgery is intricate and can take up to eight hours in total. Your child will leave the theatre and be taken straight to the intensive care unit where monitoring and intravenous fluids will be vital or comfort and pain relief. This is not for long though as most children who receive spinal fusion surgery will be back on a ward within 24 hours and remain there for another week or until well enough to return home. Your child will then need to have enough time off from school to recuperate fully. A spinal brace may also be required short term (about six months) after spinal fusion surgery purely for support to the spine and lower back.
As with most surgical procedures there are risks to be considered and spinal fusion surgery is not without theses risks. You as parents need to be aware of the risks entailed and also be ready for the spinal fusion specialist to refuse to carry out the surgical technique. The typical risks are what are known as rod displacements – where the rod can move from its original position and have to be re done as pain is excruciating, pseudarthosis – where the bones fail to graft correctly. The discomfort is relatively mild although further spinal fusion surgery will be necessary, infection – this is common but modern antibiotics can usually treat infections and lastly nerve damage – this can vary in severity with simple numbness in the legs to paraplegia. Neurologist specialists are usually present during the spinal fusion therapy though in case this risk manifests itself.
A range of services are available on the NHS which can help correct scoliosis during childhood such as osteopathy (manipulation of the bones and muscles), physiotherapy, reflexology, acupuncture, and electronic stimulation which treat nerves in the back.
Scoliosis rarely has complications when being treated, but if scoliosis is left untreated then serious and dangerous complications can occur. Kyphosis can cause a twisting of the upper spine leaving a hunched back. Kyphosis will also need spinal fusion surgery and the wearing of brace. Heart and Lung problems appear in scoliosis cases where the scoliosis spinal curvature is more than 70 to 100 degrees. The heart and lungs can be crushed by the pushing ribcage forcing breathing problems and limitations to the function of the heart. This type of damage to the heart and lungs can lead to pneumonia and heart failure.