Scoliosis: symptoms, causes and treatment

A healthy spine curves gently in and out when seen from the side, but looks straight from behind. South Tees Hospitals explains that scoliosis is a curvature in all three planes: side to side, front to back and rotating. As the spine curves and twists it turns the ribcage round, which changes the shape of the body. The Royal National Orthopaedic Hospital describes the spine as curving in an S or C when seen from the back.

The curve can occur in any part of the spine, or in more than one part. South Tees says the most common regions are the chest (thoracic) and the lower back (lumbar). It also states that a sideways curve of less than 10 degrees is considered normal and not scoliosis, and that about one in twenty people has scoliosis, usually in a very mild form that goes undetected.

The NHS lists a visibly curved spine, leaning to one side, uneven shoulders, one shoulder or hip sticking out, ribs sticking out on one side and clothes not fitting well. South Tees adds a waist that looks uneven and a hump in the back when bending forwards, which is why clinicians often ask a child to bend over during an examination.

Some people with scoliosis have back pain, which the NHS says is more common in adults with the condition. The NHS advises seeing a GP if you think you or your child has scoliosis; it is unlikely that anything is seriously wrong, but it is best to have it checked.

• One shoulder higher than the other, or one shoulder blade sticking out.

• An uneven waist or hips, or the body leaning to one side.

• A rib hump or prominence on one side when bending forwards.

• Clothes that no longer hang evenly.

The NHS says treatment depends on age, how severe the curve is and whether it is likely to get worse. Many people need none. Babies and toddlers may not need treatment as the curve might improve over time, but a plaster cast or plastic brace may be fitted to stop it getting worse as they grow. Older children may wear a back brace until they stop growing.

South Tees describes three main routes: regular clinic reviews until fully grown, a brace fitted by the hospital orthotics team, and, for a severe, progressing curve, surgery. If a child is not fully grown, a temporary growth rod can be inserted and lengthened as the spine grows until permanent corrective surgery can be considered. The Royal National Orthopaedic Hospital describes posterior or anterior approaches and says a single-stage operation is likely to mean a stay of around 5 days.

Most scoliosis is idiopathic. The NHS says your genes may make you more likely to get it as it sometimes runs in families. South Tees says it usually happens in adolescence and more often in girls, and notes that research suggests a genetic link though this has not been determined.

The NHS lists less common types: congenital scoliosis, where the spinal bones do not form properly in the womb and the curve is present from birth; neuromuscular scoliosis, linked to conditions such as cerebral palsy or muscular dystrophy; and degenerative scoliosis, from wear and tear of the spine in older adults. South Tees adds Marfan syndrome among the conditions that affect nerves and muscles and can lead to scoliosis.

The NHS says scoliosis most often starts in children aged 10 to 15, but can affect people of any age, from babies to adults. South Tees says it usually happens in adolescence and more often in girls. Having scoliosis or wearing a brace can be hard and may affect body image and self-esteem, particularly in children and teenagers.

The NHS says babies and toddlers may not need treatment as the curve might improve over time, though a plaster cast or plastic brace may be fitted to stop it getting worse as they grow. Older children may wear a back brace until they stop growing. South Tees says a brace needs to be worn for a minimum of 16 hours a day, so usually overnight as well as part of the day. Children are usually reviewed regularly until fully grown.

The NHS says an X-ray of the back is carried out to check how big the curve is. South Tees describes a detailed history, a physical examination looking at posture, reflexes and muscle power, and X-rays taken at first and then regularly to monitor progression. The angle of the curve can be measured and treatment decided accordingly.

An MRI scan may be requested to rule out an underlying neurological or bony problem. South Tees explains that clinicians ask about the start of periods because the growth spurt around that time is when curves are most likely to progress, and that if periods started more than two years earlier there is much less chance of progression, which sometimes changes treatment decisions.

The NHS says adults may need treatment to relieve pain, such as painkillers and spinal injections, and very occasionally surgery. It says it is not clear whether back exercises improve scoliosis, but general exercise is good for overall health and should not be avoided unless your doctor advises it. The condition tends to stay the same after growth stops, so see a GP if it gets worse.

Having scoliosis or wearing a brace can be hard and may affect body image and self-esteem, particularly in children and teenagers, the NHS says. Support groups can be a good source of information and may be able to put you in touch with others in a similar situation, and the NHS names Scoliosis Support & Research as one. Most people lead full lives, including sport.

The NHS advises seeing a GP if you think you or your child has scoliosis. It says it is unlikely that anything is seriously wrong, but it is best to have it checked. Adults with a known curve should see a GP if it gets worse or if back pain is becoming troublesome.

On the NHS, a GP can refer you or your child to an orthopaedic or spinal service. South Tees describes clinic reviews until fully grown, a brace fitted by the orthotics team, and surgery for a severe, progressing curve, with an X-ray used to track the curve.

Private spinal consultants offer assessment, X-rays and surgery. Because most curves need only monitoring, ask what the angle of the curve is, whether it is likely to progress, and what the plan is if it does, before agreeing to bracing or an operation.