What is Scoliosis?
An abnormal sideways lateral curvature of the spine, with the vertebrae rotating as the spine bends. Curves are described by location, direction, size (Cobb angle) and underlying cause. Idiopathic scoliosis — most commonly adolescent (AIS) — accounts for around 80% of cases. Scoliosis can also develop with increasing age, as the disc degenerates more on one side that the other, this leads to the development of lateral bend and can progress with time. This commonly affects the lumbar spine.
Causes
Most commonly idiopathic (cause unknown). Other causes include congenital vertebral malformation, neuromuscular conditions (cerebral palsy, muscular dystrophy, spina bifida), post-traumatic or post-surgical, osteoporotic compression fractures, inflammatory disease (ankylosing spondylitis), syndromic conditions (Marfan, neurofibromatosis), and rarely tumour or infection.
Symptoms
Many curves are asymptomatic. When symptoms occur they fall into three groups: postural and cosmetic concerns (uneven shoulders or waist, rib prominence, leaning posture); pain (mechanical back pain, radiculopathy from a pinched nerve, claudicant leg pain from spinal canal narrowing); and functional limitation (reduced walking distance, difficulty standing upright, reduced flexibility, fatigue, and in severe thoracic curves, reduced breathing capacity).
Diagnosis
Careful history (onset, progression, family history, bone health), and physical examination including standing posture from front, back and side; assessment of shoulder, waist and pelvic symmetry; Adams forward bend test for assessment of a rib hump; range of movement; and a full neurological check of the arms, legs and abdomen.
Imaging
Standing whole-spine X-rays (EOS) are the cornerstone — front-and-side views allow accurate Cobb angle measurement and assessment of overall spinal balance. MRI is used for leg pain, neurological symptoms, atypical curves or if considering surgical treatment. CT for bony detail and also for surgical planning. DEXA scans are used in older adults to assess bone health.
Treatment
The great majority are managed without surgery. Non-surgical care: activity, structured physiotherapy (core, postural, mobility), simple analgesia (paracetamol, NSAIDs, nerve-pain agents) and CT-guided steroid injections for nerve pain. Bracing prevents progression of 25–40 degree curves in growing adolescents but is typically not recommended for older patients or people who are no longer growing. A brace will not typically correct the scoliosis but aims to keep the curve magnitude stable as the spine grows. Surgery is considered for higher degree curves, persistent symptoms, clear progression of the curve, significant nerve compression or loss of spinal balance.