Scoliosis of the spine is a commonly known condition of the back. Scoliosis is the abnormal sideways curvature of the spine and can be classed as either functional or structural.
Treatment for most people involves using conservative care, such as chiropractic, and only in extreme cases surgery for correcting a scoliosis. Chiropractors are trained to do orthopaedic tests for scoliosis, like Adams Test, and to take and read x-rays of the spine to determine if there is structural scoliosis.
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Abnormal Curvature of the Spine
Scoliosis is a spinal deformity that should not be confused with the normal curvatures of the spine (kyphosis & lordosis).
Scoliosis is defined as:
A curvature in the coronal plane, which is an anatomic description.
Scoliosis of the spine can be both sideways (lateral) bending and with or without rotation of the spine. This abnormal spinal curve can occur at different levels of your spine so the spine can end up being either ‘C’ shaped (one curve or ‘S’ shaped (2 curves).
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The Rate of Scoliosis in the UK
The reported prevalence of scoliosis in the UK can vary, but according to research of NHS records¹ scoliosis occurs between 5.75/100,000 to 2.8/100,000.
Scoliosis is most commonly diagnosed in children and teenagers as their spines are growing and typically stops progressing when skeletal maturity is reached.
A qualified healthcare professional, such as a chiropractor, can make the final diagnosis of a scoliosis. This diagnosis of scoliosis of the spine is done via a physical examination and confirmed on x-rays of the back.
However, you can try see for yourself if there is an abnormal curve in someone’s back you know.
You can suspect there might be an abnormal curvature of the spine by asking these questions:
- Is one shoulder-blade more prominent?
- Is one shoulder higher than the other?
- Does one hip seem higher than the other?
- Is there noticeable rounding or hunching of the shoulders?
- With arms by the side whilst standing is there more space between one arm and the side than the other?
These are some basic changes in a child’s spine you may spot that could make you suspect a scoliosis in your child or a friend/family member.
Most cases of scoliosis have an unknown cause or other in other words it is an idiopathic scoliosis.
The two main classes of scoliosis are either functional or structural.
Functional scoliosis is usually a ’soft’ or non-rigid abnormal curvature in the spine. This may be due to poor posture, muscle imbalance, functional leg length differences due to muscle contractions or pelvic imbalance etc… Functional scoliosis of the spine is not a major concern as a change in movement pattern can usually rectify curvature situation quickly.
Structural scoliosis is the more worrying long-term form of scoliosis people have. The most common type of structural scoliosis is an adolescent idiopathic scoliosis. Structural scoliosis is usually detected between the ages of 10-18. Again why this happens to the back bone is unknown, however, there may be a family history of scoliosis so a genetic link is likely.
Some other types of structural scoliosis are:
- Infantile idiopathic (before 3 years)
- Juvenile idiopathic (3-10 years),
- Congenital – e.g. hemivertebrae
- Neurological – e.g. spinal tumors
- Traumatic – e.g. fractures
- Metabolic – e.g. rickets
As you can see there are many different types of scoliosis. This is why it is important to have a healthcare professional, assess yourself or your child’s spine to help you find determine if there is a scoliosis curve which type of scoliosis it actually is.
In children it is especially important to monitor and classify a scoliosis.
I remember a GP friend whose child developed a neurological scoliosis because of spinal tumours. She felt so bad for missing the scoliosis curve in her child. However, it was a rare case of spinal cancer in a four-year old.
So just get an opinion from a doctor, if needs they will refer for an x-ray to determine the Cobbs angle used to measure the severity of a scoliosis curve.
As mentioned earlier conservative care, is considered the best option to manage any pain related to a scoliosis of the spine.
When trying to determine what treatment is needed it is common to use the Cobb Angle. Cobb angle is a radiographic measurement done on an x-ray to determine how big of an angle the curve(s) are in a scoliosis.
- A Cobb Angle less than 25° only conservative care should be considered,
- Cobb angle of 25°-45° spinal bracing, such as a Boston brace, & conservative care,
- Over 45° scoliosis angle is a surgical candidate.
The Bottom Line
Scoliosis is an abnormal sideway curve of the spine that typically occurs in children and teenagers for no apparent reason.
To fully diagnose a scolisis x-ray with measurement of the curve will be needed. Curvatures greater than 25° using Cobb angle may need more intervention than just observation.
Scoliosis needs to be monitored in children and teenagers as their spines are still growing as scoliosis can get worse in these age groups. Your doctor may refer your child for x-rays every 6-12 months to reassess the Cobbs angle used to measure a scoliosis. Cobbs angle on a x-ray greater than 45° surgery is considered.Image credit: Some rights reserved by nowhere Zen New Jersey
- Goldacre, M., Fairbank, J. (2006) Geography of scoliosis in England. Journal of Bone and Joint Surgery – British Volume, Vol 90-B, Issue SUPP_III, 436-437