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Wimbledon Clinics
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September 09, 2019

Scoliosis: Types, Causes and Treatment

 

Scoliosis is a condition that causes the spine of an otherwise healthy person to curve to the side. It can curve to the left or right, or sometimes there may be two curves (a double curvature), which can result in an S-shaped spine. As well as curving, the spine can also twist, which may pull the ribcage out of position and can cause a lump to form on the person’s back or make it appear particularly rounded. The waist may appear uneven or one shoulder blade may protrude more than the other. Ironically, a double curvature may actually cause the spine to appear straight as the two curves can sometimes cancel each other out.

The curvature may occur in different parts of the spine, including the upper spine and the lumbar area. Thoracic scoliosis, which affects the chest area, can have a detrimental impact on lung performance.

 

Causes of scoliosis

Scoliosis is relatively common, affecting as many as four children per 1000 and causing them to need specialist clinical support. It is not linked to disease or lifestyle choices. In most cases the precise cause is unknown – referred to as idiopathic – but some types of scoliosis can be due to a neuromuscular condition like cerebral palsy or muscular dystrophy. It can also be linked to syndromes such as Marfan syndrome.

 

Types of scoliosis

Different types of scoliosis can affect people at different stages of life:

  • Congenital scoliosis occurs before birth. It is the result of the spine failing to develop fully in the womb. One or more of the vertebrae, which are the small bones that make up the spine, may not develop, causing the spine to grow unevenly after birth.
  • Early onset scoliosis develops in young children, between birth and puberty. In very young children, early onset scoliosis can sometimes self-correct without treatment however more pronounced curves will normally require treatment. In younger children, boys are more likely to be affected while in older children scoliosis is more common in girls.
  • Adolescent idiopathic scoliosis affects older children and teenagers. The cause is not fully understood although the condition appears to run in families. It is more common in girls although both girls and boys are affected.
  • Degenerative and de novo scoliosis affects adults. Degenerative scoliosis affects adults who have had a history of scoliosis. It is caused by wear and tear due to ageing. De novo (new) scoliosis appears first during adulthood. It is also due to wear and tear as a result of ageing. In both cases, the condition is generally diagnosed after the age of 50 and is linked to degeneration of the facet joints and discs of the spine.
  • Neuromuscular scoliosis is caused by a neurological or muscular condition, such as spina bifida or cerebral palsy, which affects the body’s nervous system. Neurological conditions are the result of damage to the brain or nerves due to injury or illness. This can affect the muscle-nerve pathways that travel from the brain to the spinal cord. As the trunk muscles weaken, the spine can collapse. The collapse is progressive, resulting in a worsening curvature.
  • Syndromic scoliosis is caused by one of a range of syndromes, normally linked to connective tissue disorders such as Ehlers-Danios and Marfan’s syndrome.

 

Scoliosis treatment options

There is a range of different treatments for scoliosis, depending on the type and severity of the condition. Treatments include:

  • Bracing – This is mainly used for children and adolescents with relatively mild curvature of the spine. Braces are worn until the individual is no longer growing. Some people may choose to wear them after they have stopped growing to help improve posture and balance. The aim of bracing is to prevent the curve from worsening. There are three different types of brace – cast, rigid and non-rigid dynamic. A spinal specialist will advise you on the best type for your particular symptoms.
  • AIS (adolescent idiopathic scoliosis) surgery – If you have AIS scoliosis and your curvature is around 45-50 degrees or more, you may be offered spinal fusion surgery to prevent the scoliosis from worsening and to correct the curvature as much as possible. Surgery is not suitable for everyone so the surgeon will discuss your particular circumstances with you so you can make an informed decision.
  • Vertebral body tethering – This is a new surgical technique for certain types of scoliosis. It was developed in the US and has only recently become widely practised in the UK. It involves making an incision through the side of the chest between the ribs and using cable to act as a tether to hold one side of the spine in place.

 

Contact us to find out more about the different treatment options available for scoliosis.

 

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