Spinal scoliosis is a sideways curvature of the spine. Depending on the reason for development of this curvature it is important to recognise it if present, as if left unchecked it can permanently alter the individual’s function and appearance for life. In the whole population, scoliosis affects 2% of all females and 0.5% of males. Although scoliosis can occur at any age, 80% of cases develop in early teens.
Permanent scoliosis can be a component of neuromuscular presentations such as spina bifida or cerebral palsy. It can occur because of a congenital vertebral malformation, or may be a consequence of leg length inequalities (one leg growing longer than the other). Short-term scoliosis may be present in acute disc presentations or rarely, spinal tumours.
However the most common form is called idiopathic scoliosis: a sideways curvature that develops for no discernable reason, often relatively painlessly, starting around puberty and continuing to worsen through the early teen years. The word idiopathic is the medical term used to denote ‘for unknown reason’. Idiopathic scoliosis is a condition that every parent of teenagers should be aware of, as a simple visual test can pick up the problem. Early detection allows for best management of this condition that affects one in every 50 teenage girls and one in 200 boys. If a parent knows there is a family history of scoliosis it is especially important to check as this is one of the known risk factors.
Apart from scoliosis related to neuromuscular presentations, in the otherwise healthy teenager, idiopathic scoliosis is a mix of abnormal bony growth in the spinal vertebrae, usually centred around the mid to lower ribcage region and muscular abnormalities in terms of spasm on one side of the spine, with wasting on the other. It is unclear which appears first: the abnormal vertebral changes or the muscle wasting. As the scoliosis twists the spine sideways there are implications for the ribs, lungs and even internal organs as their function may be compromised by position of the spine. Usually scoliosis is active throughout the growth years of adolescence, during which time there is a window of opportunity to influence the long term outcome.
By the age of eighteen to twenty, if left untreated, the curvature of the spine becomes fixed in with lifelong implications. For example, scoliosis will preclude certain occupations of a physical nature. Contact sports are not recommended for adults with fixed scoliosis, nor are extreme pursuits such as rock climbing or bungee jumping appropriate, as the spine is much less able to tolerate jerks, bumps and awkward positions.
As teenagers in the main want to look and behave exactly as their peer group, scoliosis can have negative effects on individual’s self-esteem and confidence. Postural implications of scoliosis include the development of a noticeable bony hump on one side of the ribcage, inability to stand up fully straight and shoulders of different heights. All this may create problems in getting clothes to fit in a manner so as to reduce the physical appearance of the spinal curvature. This can be psychologically difficult for teenagers of both sexes but especially for girls as they proceed through life.
Once scoliosis is suspected, a spinal x-ray will confirm the presence of idiopathic scoliosis and allow doctors to assess both whether bony abnormalities are present and also allow for mathematical calculation of the curvature. Adolescents with scoliosis are regularly monitored throughout their teenage years by paediatric orthopaedic teams in specialised scoliosis clinics around the country. Surgery, where steel rods are inserted to straighten the spine is the correct option for aggressive idiopathic scoliosis, but as the condition can range from mild to aggressive, surgery is not necessary in all cases. If the curvature is picked up early, non critical on measurement and not worsening, medics may take a sensible approach to wait-and-see. Often physiotherapy in offered to improve spinal flexibility and teach strengthening exercises. Muscle stimulators are used to alter the incorrect muscle pattern associated with scoliosis. In general children are encouraged to continue to be active and play sport, though perhaps not contact sport for fear of further trauma to the spine. Swimming is especially recommended.
So to return to the parent’s role in picking up idiopathic scoliosis, what should you know and do? The first thing is to be vigilant, especially if there is a family history of scoliosis. Next, view your teenagers with searching eyes every couple of months. The shoulder area is where you get first clues. Though many teenagers develop (and growth out of) rounded shoulders, it is more the level of the two shoulders which is of interest in idiopathic scoliosis. Watch for one higher than the other. This is not as easy as you think as many teenagers slough around in several layers of hoodies, making it impossible to see nay part of their physique clearly. Next is the difficult bit. However, keep an eye on their posture perhaps at the breakfast table when wearing nightwear. Be suspicious if their back does not appear smooth and eve or if one shoulder is permanently higher than the other.
The clear visual test, which every parent should know is easy to perform. Standing behind the child, ask them to bend towards the floor, keeping knees straight. The parent should crouch until they are at eye level with the highest point of the spinal curve and then just observe across either side of the spine. This is called the skyline view. Normally this view will be level across the horizontal. In idiopathic scoliosis what is seen is a distinct hump on one side of the ribcage, with a flattened region at the same level on the other side of the spine. If this is the case, you should confirm it with your GP, who will take it from there.
This simple bending test is worth performing every three months in early adolescence, even more frequently if a familial history exists. Early assessment leads to best outcome. Public Health Nurses and PE teachers formally perform this test in schools at least once in early adolescence, but keeping a watching brief on a developing teenager’s back is well worth the parental effort.
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