Scoliosis: symptoms, causes and treatment
Scoliosis is a curvature of the spine in which it twists and curves to the side. It can affect people of any age but most often starts during the growth spurt before puberty.
Dr Colin Nnadi, Consultant Spine Surgeon at The Portland Hospital, part of HCA Healthcare UK, looks at the symptoms, causes and treatments for scoliosis:
What is scoliosis?
Scoliosis is a sideways curvature of the spine, often appearing like an ‘S-shape’ as it twists and curves. Severity can vary quite a lot from case to case, from a slight curve in minor cases to twists and curves in the spine that are so severe that they’re disabling.
Common types and causes of scoliosis
There are lots of different types of scoliosis, but they fall into three main categories: idiopathic, congenital, and neuromuscular. When these categories occur in children under the age of 10 years they are described as Early Onset Scoliosis (EOS). It is important to treat children with EOS as soon as possible in order to prevent lifelong problems with lung and heart function.
• Idiopathic scoliosis
This the most common type of scoliosis – and essentially means a case of scoliosis with no one clear cause. Many cases of idiopathic scoliosis are diagnosed during adolescence, during the period of sudden growth that many teenagers experience.
• Congenital scoliosis
Congenital forms of scoliosis are forms of the condition that has been caused by spinal defects present at birth. Congenital forms of scoliosis are often diagnosed earlier but are fairly rare, affecting just 1 in 10,000 newborns.
• Neuromuscular scoliosis
This refers to forms of scoliosis that are considered to be secondary to an underlying disorder of spinal cord, brain or muscular system. These forms of scoliosis may occur when the nerves and muscles surrounding the spine are unable to support the condition.
Scoliosis symptoms
The symptoms of scoliosis will vary depending on the severity of the case and its cause – but there are some key signs you can look out for:
A visibly curved spine
Uneven shoulders
The shoulder, hip or ribs sticking out on one side
Leaning to one side
Clothes not fitting well
Muscular pain or discomfort
Scoliosis risk factors
There are a few risk factors for scoliosis which increase the chances of developing the condition. Other than an underlying condition that predisposes the sufferer to developing scoliosis, including cerebral palsy, osteogenesis imperfecta and muscular dystrophy among others, there are three main risk factors:
• Age: For idiopathic scoliosis in particular, children and adolescents undergoing a growth spurt are at increased risk.
• Sex: Although rates of mild scoliosis are similar in boys and girls, girls are at increased risk of severe scoliosis requiring treatment.
• Family: Although most people with scoliosis don’t have a family history of scoliosis, having a close family member with the condition may increase the risk.
Scoliosis complications
Most people with scoliosis will have a mild form that doesn’t cause significant complications. For those with more severe forms of the condition, complications can occur but these are unlikely to happen because of monitoring and treatment offered for scoliosis today.
If the ribs become twisted or misshapen, the function of the heart and lungs can be affected leading to breathlessness, particularly during strenuous exercise. Similarly, an altered chest cavity shape can leave little room for the heart to beat and cause potential heart failure but this is very rare.
Pain is a more common complication either from the muscles, ligaments and joints directly or from compression of nerves by the altered anatomy. Sitting or standing in any one position for too long can cause discomfort as muscles tire of trying to maintain a good posture.
The physical appearance of scoliosis, or of wearing a back brace, can also be quite tough emotionally on people with the condition – both children and adults struggle with their body image as a result of scoliosis. Joining a support group and talking to others with the condition can be very helpful.
Scoliosis treatments
Many children and adults with scoliosis will not need treatment, just monitoring through regular x-rays to ensure the curvature doesn’t increase or cause discomfort.
Simple pain relief such as paracetamol may be sufficient to ease any pain from scoliosis. Stronger pain medication is sometimes required and this may include specific medications used to dull nerve pain, if this is thought to be the root of the pain. Steroid injections into the spinal nerves and joints may be offered as a short term option if the pain is severe. Hydrotherapy and massage can be beneficial too.
Children and teenagers may be given a back brace to wear for a certain period of time each day, with the aim of preventing the curvature becoming worse as they grow. Back braces may help to support the muscles and ease pain too.
Exercise is an important part of treatment for scoliosis, particularly for adolescents. Initially started under supervision from an experienced physiotherapist, many of these exercises can be carried out at home, to encourage strong and supportive spine muscles, good posture and reduced deformity. They can also help to alleviate symptoms such as muscle pain and stiffness.
For some rare, severe cases, surgery may be needed to straighten the spine. This surgery is usually only recommended for adults and older children who have stopped growing.
Scoliosis lifestyle tips
If you suspect that you or your child has scoliosis, you should see your doctor to get checked out. If they suspect scoliosis, they can refer to a specialist for diagnosis and to discuss options.
Unless your doctor advises otherwise, it’s good to stay generally active, fit and well – your doctor may be able to advise on specific exercises and an assessment by a physiotherapist is invaluable.
It's important to recognise the stress that living with scoliosis can cause. Whether it's worries over body image, pain or pending surgery, the impact can be huge. People with scoliosis have an increased risk of developing depression. Support groups, talking with friends and family and where needed, advice from a mental health professional, will all help to ease the stresses caused by scoliosis.
Last updated: 12-08-2020
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