Scoliosis is the medical term that describes the abnormal twisting and curvature of the spine. It occurs most often during the growth spurt just before puberty. It affects around three to four children in very 1,000 in the UK and is most typically seen in children between the ages of 10 and 15. It is also more common amongst females than males. In 8 out of 10 cases there is no known cause; this is known as idiopathic scoliosis. The majority of the rest of cases are caused by medical conditions: cerebral palsy, muscular dystrophy and Marfans syndrome.
When scoliosis is suspected, the individual should be referred to a Spinal Consultant who will coordinate treatment. Weight-bearing full-spine X-rays are usually taken to assess the scoliosis curves and the kyphosis and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X-rays are the standard method for evaluating the severity and progression of the scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at three- to 12-month intervals to follow curve progression.
The standard method for assessing the curvature quantitatively is measuring the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebra involved and the lower endplate of the lowest vertebra involved. For people with two curves, Cobb angles are followed for both curves. In some people, lateral-bending X-rays are obtained to assess the flexibility of the curves or the primary and compensatory curves
Mild cases may self- correct as a child grows, though we may also recommend wearing ‘dynamic’ lycra garment which can offer a mild corrective force and improved proprioceptive feedback.
In moderate or severe cases, where there is risk of curve progression, a brace may be recommended. We employ a bespoke spinal brace design based on the Boston Blueprint method. This technique has been proven to be effective and is employed by the Royal National Orthopaedic Hospital - one of Europe's largest scoliosis treatment centres - where Martin Middleton worked as a scoliosis specialist for 12 years. Below you will find a helpful video of the bracing procedure.
Some cases will ultimately require surgery. Surgery for scoliosis is performed by a surgeon specialising in spine surgery. For various reasons, it is usually impossible to completely straighten a scoliotic spine, but in most cases, significant corrections are achieved. Surgery is indicated by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) at 45 degrees to 50 degrees and by the Scoliosis Research Society (SRS) at a Cobb angle of 45 degrees.
The two main types of surgery are:
Anterior fusion: This surgical approach is through an incision at the side of the chest wall.
Posterior fusion: This surgical approach is through an incision on the back and involves the use of metal instrumentation to correct the curve.
One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, takes four to eight hours.