My Twist on Scoliosis

Scoliosis is the name used to describe the condition of having a curved or twisted spine.

It is not a disease, it's not infectious, and you cannot 'catch' it.

THINK " S " FOR SCOLIOSIS

Like the letter "S" the spine is curved if you have scoliosis, either a side-to-side, lateral curve, or a forward curve.

Some people's curve is shaped like the letter "C" or they may have a 'hump' at the top of the back.
Terms such as kyphosis and lordosis are descriptive terms used for varying spinal curvatures.

A low curve can affect the hips and one hip will be higher than the other. In effect this makes one leg shorter than the other.

Pain and balance difficulties can result from this, as the body's inbalance puts strain in the muscles of the back. Wearing a built-up shoe will compensate for this difference.

There are natural curves in the spine, so it's possible that you do have a slight curve in your back, but this is usually considered normal.

A diagnosis of scoliosis is made if the angle of the curvature is over ten degrees.
This angle is known as the Cobb Angle or Cobb's Angle.

Back pain and back problems are quite common, and may be due to many causes.
Scoliosis may also cause similar problems.

A severe curvature of the spine may lead to disability or handicap, which in some cases can be eased by surgery for scoliosis.

Curvature of the spine can arise from many different causes. Scoliosis back problems can vary from person to person.

CONGENITAL SCOLIOSIS is present at birth and is the result of malformation of the baby in the womb.
It is not predictable, and is not the result of anything the parents did or failed to do.

Scoliosis can develop DURING CHILDHOOD, especially during periods of rapid growth, such as adolescence.
If one side of the body grows quicker than the other then curvature of the spine can develop.
It may remain mild and improve with exercise, but treatment could be needed for more serious curvatures.

It is advisable to check your children for signs of uneven development. See below for the section:
HOW TO DETECT SCOLIOSIS IN A GROWING CHILD

This type of scoliosis may have a genetic component, and occurs more often in girls than in boys (approx 80%)
Thirty percent of people with this type of scoliosis have at least one closely related family member with the same condition.
Current research predicts that over ten different genes may be involved.
These include genes for growth & development, ligament formation and body symmetry.

It may arise from GENETIC CONDITIONS such as Marfans and Ehlers Danlos Syndrome (both of which affect collagen in the body), or other conditions such as Klipper-Feil Syndrome and Charcot-Marie-Tooth Disease.

INFECTIOUS DISEASES can sometimes cause Scoliosis e.g.Poliomyelitis.
Serious outbreaks of Polio during the 1950s and 1960s left many children with permanent chest and back deformities. Fortunately Polio is virtually unknown now.

TRAUMA such as fracture deformities from road traffic accidents or following spinal surgery, can be the cause of back problems.

DEGENERATIVE CONDITIONS can be the cause - Osteoporosis for example - and wear & tear to the body as we age. These may bring on various back problems such as curvature of the spine, or sometimes a humped appearance at the top of the spine.

Treatment for scoliosis can achieve excellent results if started early enough.

Regular check-ups by your family physician should include examination of your children's backs.
But you can also watch out yourself for any indications of spinal curves.

Examine your children during periods of rapid growth (such as adolescence) to check for signs of uneven development.

It's a sensible idea to do the following test from time-to-time as changes can happen so quickly.

This examination is very simple and quick, and is known as the

FORWARD BEND TEST

Here's how to do it.

The child should be bare-backed.

Ask the child to bend forward from the waist, keeping their arms and legs straight and their palms together.
Look along the child's back to see if there are any differences on the two sides.

Check for these signs:

One shoulder-blade being more prominent or higher than the other

A tendency to lean a little to one side

A clear bump or hump on one side

Uneven hips

One leg shorter than the other

A noticeable curve in the spinal column

If you see any of these signs consult your medical practitioner who can refer you to a specialist.

It is important to deal with a progressive curve AS SOON AS POSSIBLE.

If a child's Scoliosis is diagnosed early enough, good results may be obtained from non-surgical treatments such as exercise, physiotherapy or 'bracing'.

A brace, such as a Boston Brace or a Milwaukee Brace, is used to prevent worsening of the curvature.

Many children are not diagnosed until the curve is too great to attempt bracing, in which case surgery may be offered.

The Boston Brace is a rigid, body-shaped brace, rather like a stiff corset, which fits the body closely, from the shoulder blades to the hips.

It will be custom-made to fit your child, and replaced with a larger one as the child grows.

Made from a plastic material, it is lined with a foam padding, and has pads inside.
These pads exert gentle pressure on the body, moving it into an upright position.
This helps to hold the spine up straight.
It cannot straighten the spine but helps prevent the spinal curvature from increasing.

It will be used during the time that the child is growing.

A brace is worn under loose clothing, with a tight-fitting vest or T-shirt underneath, to prevent chafing.

The brace does not affect most normal activities - the child can attend school as usual, but will not be able to take part in anything strenuous such as gymnastics.

If swimming is recommended as a good exercise, the brace can be removed for this.
Arrangements may have to be made for someone to help the child to put the brace back on while getting dressed afterwards.

At the start of treatment the brace is worn for increasingly longer periods of time.

Eventually it will be worn for up to 22 or 23 hours a day, but towards the end of treatment this may be reduced to night-time only.

Treatment will depend on the individual patient, the cause of their scoliosis, and their personal decisions.

Many people, both young and old, find exercise helpful especially Yoga and Pilates. Children showing early signs of spinal curvature can be helped by wearing a brace while they grow. For the more serious cases there may be surgical options.

The aim of an operation is to straighten the spine, and fuse it with a combination of titanium rods, screws and hooks.

Not all cases of scoliosis will benefit from surgery. Some spinal curves do not need surgery, some people do not want to have surgery, and for a few, surgery would not be able to correct the problem.

Some adults who have a spinal curve may decide against having spinal surgery. At this stage in their life they will have become used to it, be able to cope with it, and be happy to live with their differences.

For them, a possible improvement to the appearance of their back wouldn't be a good enough reason to warrant an operation. Unless their curvature is giving rise to symptoms such as pain they will be content to leave things as they are.

However, for a younger person, appearances may be very important and they may want it dealt with as soon as possible.

Early on-set of Scoliosis can have psychological effects on the child, especially during adolescence.

At this stage in life anything which sets you apart from your peers can be very upsetting.
It may be difficult to fit in with the crowd when fashionable clothes just do not seem to fit you properly, and physical differences are becoming noticeable. Dating and relationships may seem to be a major problem to the young adult.

Feeling excluded, or being subjected to bullying, can lower self-esteem, destroy confidence and lead to depression.

This is why it is important to get treatment as early as possible, and regular checks of the child's back, as detailed here, are advisable.

If scoliosis is detected in its early stages bracing can be attempted, and the surgical option may not be suggested.

Results of both bracing and surgical procedures can be excellent.

Full discussions should take place with your consultant, before agreeing to surgery.

The topics to discuss would include such things as:

Is surgery imperative?
Will there be long-term pain or physical impairment if NO surgery is carried out?
Would having the surgery cause post-operative pain or long-term pain?
After surgery, is there a likelihood that further remedial surgeries will be needed in the future, and could there be long-term disability?

It's good to talk to others who have been through it themselves, perhaps on forums and internet boards.
It can help you to feel less isolated, and to find information.
But remember that every case is different.
Their experiences may differ from yours, and that's why you need to hear from your own physician.