In most cases, scoliosis develops in otherwise healthy children. When health professionals can’t find a cause for it, it’s called idiopathic scoliosis.
Idiopathic scoliosis can start at any age during childhood and adolescence, but it most commonly starts during a growth spurt, usually in adolescence.
Idiopathic scoliosis is named according to the age at which it starts:
- Early onset idiopathic scoliosis (EOS) happens at 0-10 years.
- Adolescent idiopathic scoliosis (AIS) happens at 10-18 years.
Idiopathic scoliosis can develop quickly during a child’s growth. The more quickly a child grows, the more likely scoliosis is to develop quickly.
Idiopathic scoliosis is also described as mild, moderate or severe, depending on how curved the child’s spine is.
Scoliosis affects approximately 2-3% of children and teenagers. It’s more common in girls than boys, particularly in girls aged 10-13 years.
Causes of scoliosis
Most cases of scoliosis are idiopathic, which means there’s no obvious reason why a child has it.
There’s lots of research being done on the causes of idiopathic scoliosis. Scoliosis tends to run in families, so genetics might play a part in causing it.
Other causes of scoliosis
In a few cases, we do know the cause of scoliosis.
Physiological scoliosis – also known as a ‘list’ – is caused by a difference in the length of a child’s legs. The child stands with a bend in her spine as a result.
Functional scoliosis happens when some of the muscles around the child’s spine are working harder than others, perhaps as a result of something painful like a stress fracture.
Congenital scoliosis is caused by poorly or oddly formed bones in the spine. This is present before a child is born, but it might not show up until much later in life.
Connective tissue disorders, such as Marfan Syndrome, can also cause scoliosis.
Signs and symptoms of scoliosis
You might see the following in a person with scoliosis:
- unevenness of the shoulders and waistline
- the pelvis shifted to one side
- the head slightly tilted
- unevenness in the shape of the rib cage at the back, when the person bends forward.
Often a child with scoliosis doesn’t experience any symptoms. But common symptoms are a mild ache in the low or middle back area.
When children grow very quickly, the curve can also get worse very quickly. In adults, severe curves usually get worse slowly. As the curve gets bigger, it increases the risk of health problems such as back pain and shortness of breath.
Teenagers with scoliosis can have lower self-esteem and more chance of depression.
Tests for scoliosis
The forward bending test is a simple way to check for idiopathic scoliosis. Health professionals all around the world use this test.
The test involves the following steps:
- Stand with feet together and parallel.
- Place palms of hands together with arms straight.
- Bend forward towards feet with fingertips pointing between the big toes.
The observer looks at the shape of the back and views all regions – upper, middle and lower back. If one side of the back is 1 cm higher than the other side, it might be scoliosis.
To confirm scoliosis, health professionals usually order an X-ray, with images of a child’s front and sides.
An MRI is sometimes ordered for children when there’s a chance of finding an underlying cause, or for children who need surgery.
Treatment for scoliosis
Scoliosis treatments aim to stop the spine’s curve from getting worse. This can limit the chance of other health problems later in life.
Health professionals recommend different treatments depending on how severe the scoliosis is, how mature the bones are, what symptoms your child has, and other factors.
For children who are still growing, health professionals usually recommend monitoring and sometimes bracing. In rare cases they might recommend surgery.
Health professionals usually recommend monitoring for mild curves.
Monitoring usually involves repeat X-rays every 4-6 months to see whether the curve is getting worse and needs more treatment – for example, bracing.
Health professionals usually recommend rigid bracing for moderate curves and if your child is still growing.
Bracing significantly decreases your child’s chance of needing surgery to treat the curve in her spine.
The more hours your child spends in the brace, the more benefit your child will get. Many orthopaedic surgeons recommend wearing a brace for 23 hours a day, with one hour out of the brace for exercising and showering.
There are different types of rigid braces. The brace most commonly used in Asia is the Boston brace. You wear this brace underneath your clothes.
Many teenagers feel stressed and embarrassed about wearing a brace.
If your child needs a brace, having a good therapeutic team to support him is very important. This team might include an orthopaedic surgeon, an orthotist, a physiotherapist and possibly a psychologist.
Only a tiny number of scoliosis cases need surgery.
In fact, health professionals usually recommend surgery only in severe cases of scoliosis, when they think the curving is likely to keep getting worse. Other factors, such as pain and poor quality of life, might lead a surgeon to recommend surgery.
Surgery most commonly involves fixing metal rods to the spine to realign and stabilise the affected areas. Your child will usually stay in hospital for 5-7 days and go back to school 3-4 weeks later.
Severe curves often look better after surgery and generally don’t get worse over time. Surgery decreases the chance of the spine’s curve causing other health problems later in life.
We don’t know what causes idiopathic scoliosis, so health professionals can’t say how to prevent it happening. Bracing can often prevent curving getting worse.
We do know that early detection is important so that treatment can start as soon as possible. This can help avoid the need for surgery.