Scoliosis

Definition/diagnostic criteria Scoliosis is a condition where the spine twists and curves to the side, involving a three-dimensional change in the coronal, sagittal and axial planes of the spine. This causes the bones of the spine to twist or rotate, leading to a sideways curvature. Scoliosis can affect individuals of any age, from babies to adults, but most commonly begins in children aged 10 to 15​​​​.

• Idiopathic scoliosis: In about 80% of cases, the cause of scoliosis is unknown (idiopathic scoliosis). It is not linked to factors like posture, exercise or diet but may have a genetic component as it sometimes runs in families​​.
• Congenital, neuromuscular, or degenerative causes: Scoliosis may also arise from congenital spinal malformations, underlying nerve or muscle conditions (e.g., cerebral palsy, muscular dystrophy), or age-related wear and tear of the spine​​.

Epidemiology In the UK, scoliosis affects 2% to 3% of the general population and is more common in females than males. Approximately three or four in every 1,000 children require treatment for scoliosis​​.

Diagnosis
Clinical features: Signs of scoliosis include a visibly curved spine, leaning to one side, uneven shoulders, one shoulder or hip sticking out, ribs sticking out on one side, and clothes not fitting well. Back pain may also be present, especially in adults with the condition​​.

Investigations: Diagnosis typically involves a referral to a specialist scoliosis centre if scoliosis is suspected. An X-ray of the back is carried out to assess the extent of the curvature. The most common type in children and young people is adolescent idiopathic scoliosis (AIS), which is progressive and has an unknown cause​​​​.

Treatment Treatment depends on the individual’s age, the severity of the curve and the likelihood of the curvature worsening. Many individuals may not require treatment, while a small number may need spinal surgery. Treatment approaches vary by age:

• Babies and toddlers may improve without treatment, but some might need a plaster cast or plastic brace.
• Older children may wear a back brace to prevent worsening of the curve, with surgery as a possibility.
• Adults might require pain relief treatments like painkillers, spinal injections or, rarely, surgery. It’s unclear if back exercises specifically help scoliosis, but general exercise is recommended for overall health​​.

Prognosis Most people with scoliosis can lead normal lives and participate in activities including exercise and sports. The condition doesn’t usually cause significant pain or other health problems and tends to stabilise after growth stops. However, scoliosis or wearing a back brace can impact body image and self-esteem, particularly in children and teenagers​​.