Ask the expert: what is scoliosis?

Scoliosis refers to twisting and curvature of the spine and usually affects adolescents aged nine to 14 years. In the UK, three to four children in every 1,000 need treatment for scoliosis. However, scoliosis can also develop in younger children and in adults.

What happens to the spine in scoliosis?

When looking at a healthy spine front-on, the individual bones (vertebrae) that comprise the spine are stacked up, one on top of the other, forming a straight line. However, in scoliosis, the spine curves sideways; when viewed front-on, the spine takes on an S or C shape.

This curvature of the spine causes one of your hips to become more pronounced, sit higher than the other hip or stick out at an odd angle. In some cases, your shoulders may sit unevenly, your ribs may jut out and one side of your waist may appear more creased than the other.

What are the different types of scoliosis?

There are four different types of scoliosis, grouped according to the age at which symptoms first occur. As previously mentioned, most cases of scoliosis present between the ages of nine and 14 — this is called adolescent idiopathic scoliosis.

Scoliosis that first presents in adulthood is called degenerative or de novo scoliosis. Congenital scoliosis occurs before birth and early onset scoliosis occurs from birth to eight years.

What causes scoliosis?

In eight out of 10 cases of scoliosis, the cause is unknown, which is medically referred to as idiopathic. Idiopathic scoliosis can’t be prevented and although it often runs in families, this isn’t always the case.

Known causes of scoliosis include developmental problems, where the bones do not form correctly in the womb, cerebral palsy, muscular dystrophy and Marfan syndrome.

How is scoliosis detected?

In children, scoliosis is often noticed by a parent or sports teacher, particularly during activities such as swimming or dance where more tightly fitting clothes are worn. Scoliosis can also be picked up incidentally when having an X-ray for another reason. 

If you are concerned that your child may have scoliosis, see your GP. They will examine their spine and if appropriate, refer them to a spinal surgeon. 

A spinal surgeon will physically examine your child’s spine and ask them questions to assess whether their nerves are working properly. Your child will also need to have an X-ray of their spine, which will be used to measure the extent of any curvature. 

If your child has any unusual symptoms, such as severe pain, numbness or tingling, your surgeon may recommend an MRI scan to rule out other causes of these symptoms and rare causes of scoliosis, such as Marfan syndrome. 

How is scoliosis treated in children?

Treatment for scoliosis depends on your child’s age, the extent that their spine is curved and how likely it is to get worse.

Mild to moderate scoliosis

Curves of less than 10 degrees usually don’t need any treatment and in older teenagers, curves of less than 30 degrees typically only need monitoring and don’t get bigger.

Swimming and keeping fit are encouraged to prevent any pain caused by mild to moderate scoliosis. Exercise can also help prevent the curve of the spine getting worse.

Physiotherapy is also recommended to treat lower back pain or other aches and pains caused by scoliosis.

Severe scoliosis

Curves greater than 30 degrees are more likely to get bigger and risk causing deformity. Physiotherapy and exercise do not appear to help prevent further curvature of the spine in these cases.

The risk of the curve getting worse is highest in young children. Wearing a back brace can help reduce this risk and allow your child to continue with their usual activities.

Regular X-rays are needed to check the curvature of the spine and whether it is getting worse. If the spine becomes very asymmetrical, the curve grows significantly or wearing a brace becomes very uncomfortable, surgery may be recommended to straighten the spine.

How is scoliosis treated in adults?

In adults, pain or discomfort caused by scoliosis can be treated by taking over-the-counter pain relief, such as ibuprofen, or in more severe cases, steroid injections may be recommended. 

Physiotherapy, regular exercise and maintaining a healthy weight are also strongly recommended to reduce strain on the spine. 

Surgery is usually only recommended if the spine is putting too much pressure on nerves.

What are the long-term effects of living with scoliosis?

Getting a diagnosis of scoliosis can be distressing and in adolescents, in particular, can cause anxiety over their appearance. However, it is important to remember that in most cases, individuals with idiopathic scoliosis can lead full, active lives and girls can expect to have normal pregnancies in later life.

In some cases, adolescents with idiopathic scoliosis will be advised to avoid contact sports.

The key to living a full life with scoliosis is early diagnosis and treatment. So if you have any concerns about your child, see your GP.

Author biography

Mr Am Rai is a Consultant Spinal and Orthopaedic Surgeon at Spire Norwich Hospital, specialising in orthopaedics, disc herniation and spinal deformities. He is also Director of the spinal charity Spine Aid, former President of the British Association of Spinal Surgeons (BASS) and currently sits on the BASS Executive Committee. Mr Rai has performed over 3,000 complex spinal operations and has particular expertise in spinal stenosis, cervical fusion/disc replacement and minimal access keyhole surgery.