The term scoliosis refers to any abnormal curvature of the spine to the side. The spine is made up of vertebrae and is split into 5 different sections:
The cervical spine is made up of 7 vertebrae and these are the bones that make up your neck.
The thoracic spine is made up of 12 vertebrae and this is middle portion of your spine and these bones are where your ribs attach.
The lumbar spine is made up of 5 larger vertebrae; this is your lower back.
The Sacrum is composed of 5 fused bones.
The coccyx is the tailbone and is made up of 4 tiny vertebrae that are fused together.
The spine can curve to either side in a ‘C’ shape or it can have two curves and make an ‘S’ shape. The spinal column can also start to rotate and twist and this will effect the position of the ribs as they are attached to the thoracic spine. You may notice the ribs changing shape at the front or back.
Scoliosis can be present from birth (congenital), and it can also develop later in childhood (idiopathic). When scoliosis develops in adulthood it is as a result of degeneration or it can be due to a neuromuscular condition.
A congenital scoliosis is when the vertebrae of the spine do not form correctly during the first 6 weeks of embryonic development. The vertebrae can either be an abnormal shape or several vertebrae can be abnormally connected together, resulting in asymmetry with growth of the spine. There is no known cause for this malformation and it is often discovered during the infancy when the child has growth spurts. In some children it does not appear until their adolescent years.
An idiopathic scoliosis is diagnosed when the cause of curvature is unknown and it most commonly occurs in adolescents. It is relatively common, not all patients require treatment and some do not even realise they have it. The progression of the curve varies greatly from patient to patient. Some may require bracing, others will need to have surgery, and many will need no intervention. Usually patients are pain free and the only symptom is a change in posture.
Neuromuscular Conditions and the Spine
Children who have neurological conditions such as cerebral palsy, spina bifida, muscular dystrophies, and spinal cord injuries are at risk of developing a neuromuscular scoliosis. The scoliosis of the spine starts to develop due to the muscles supporting the spine not working correctly. Where there is weakness or abnormal tone it can also change the shape of the spine. Children who are unable to walk are at an increased risk of developing a scoliosis. These curves tend to be progressive and will worsen during growth spurts; often it will impact on their breathing as the shape of their rib cage changes.
The conditions of Scheuermann’s disease results in a structural change to the spine. This occurs when the front of the upper spine does not grow as fast as the back of the spine, so that the vertebrae become wedge-shaped, with the narrow part of the wedge in front. This causes the patient to become hunched forwards.
Another common cause of structural change in the lower back is called spondylolysis. This is when a stress fracture occurs where the vertebrae articulate with each other. If the vertebrae begin to slip out of place this is then called spondylolisthesis. Often the vertebrae can start to press on the nerves and this may require surgery.
The signs and symptoms of scoliosis are:
- One shoulder is higher than the other
- One shoulder blade sticks out more than the other
- One side of the rib cage appears higher than the other
- One hip appears higher than the other
- The body tilts to one side
- The body appears rotated
- One leg may appear shorter than the other
Doctors will monitor the spinal curve by carrying out yearly X-rays. They will use this x-ray to measure the Cobb angle, which is 10 degrees. This is regarded as the minimum angulation to define scoliosis. A measurement under 10 degrees is regarded as normal, between 10 degrees and 30 degrees is classed as mild, and anything over 60 degrees is severe. This will help guide their management decision.
Treatment will depend on the rate of progression and pain. Doctors will consider bracing and surgery, but this is not always necessary if the patient is fully functional and pain free. Patients will usually require a home physiotherapy programme to focus on strengthening the postural muscles of the spine and core and to maintain flexibility. These exercises will not stop the progression of the curve, but they will help to maintain function and strength. Our team of physiotherapists can assess, treat and monitor your child’s scoliosis alongside the multidisciplinary team. Contact us today on 020 7884 0374 or email firstname.lastname@example.org.