Royal Manchester Children s Hospital Scoliosis Information For Parents and Carers
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What is scoliosis? Scoliosis is a lateral (sideways) curvature of the spine. It can be due to abnormalities in the legs but is most commonly due to a problem in the spine. It usually develops during early adolescence. In most cases the curve is slight but in severe cases the spine can become C or S shaped. A normal spine appears curved when viewed from the side and straight when viewed from behind. In scoliosis, the opposite is true, that is the spine appears straight when viewed from the side yet curved when viewed from behind. Facts about scoliosis 1 in 20 people has scoliosis generally in a very mild form. Of these 1 in 20, five percent, will have a more severe spinal curvature. Scoliosis is generally not painful in young people but can become painful in adults. Scoliosis is treated most successfully when the patient is younger. The body can respond better to treatment while it is still growing. Scoliosis may increase during growth periods. Larger curves may continue to progress during adult life. Signs of scoliosis One shoulder may be higher than the other. One shoulder blade may be higher and more prominent. One hip may be more prominent than the other. Clothes may not hang right it is often difficult to get a hem to hang level or trousers to appear the same length. Girls may complain that one breast appears less prominent than the other. 3
What causes scoliosis? Eighty percent of scoliosis is of unknown cause (idiopathic). Much research is being done into this field including work at the Royal Manchester Children s Hospital. In most of these cases the condition develops in girls between 10 15 years old and is more common in the relatives of those affected. Other cases are congenital (caused by abnormal development of the bones in the spine) and some are due to problems with nerves or muscles (such as cerebral palsy or muscular dystrophy). How is scoliosis detected? Scoliosis can be seen by a trained observer looking at a patient s back. When a patient bends forward one side of the chest or loin may appear more prominent if scoliosis is present. Some education authorities screen all teenagers for scoliosis. If the school doctor has any doubts then an appointment is usually arranged at the scoliosis clinic for X-rays to be taken. Monitoring and progression of the curve Although some new photographic methods are now becoming available, X-rays are still the most reliable way of detecting any worsening in the degree of scoliosis. At the time of diagnosis there is no accurate way to predict which curves will worsen. Some smaller curves do not get worse. Many curves remain stable for years but suddenly get worse during the adolescent growth spurt. The child s potential for growth is therefore one of the most important factors in predicting curve progression. In general, patients who have a lot of growth to come have a higher risk of curve progression. Growth potential, and therefore potential for curve progression, can be evaluated by age at diagnosis, menstrual history and radiological signs of bone maturity. Overall, females with scoliosis have a greater risk of curve progression. 4
Treatment Scoliosis is treated to prevent curve progression and also to preserve good appearance. There are three main types of treatment/care: Observation Bracing and casting Surgery Observation Patients with a recently diagnosed mild curve are observed for a period of time to determine if the curve will progress. Since most curves do not become severe, observation is often all that is required. This enables the Surgeon to plan any active treatment that may be necessary. The most accurate method of observation is to perform a standing X-ray. Each X-ray is compared with the previous one to determine the amount of curve progression. Generally those with mild curves are seen in clinic every six months but those with larger curves will be seen every three to four months, especially if the child is growing rapidly. 5
Bracing Bracing maybe used when the child is growing rapidly and the curve is between 20 and 30 degrees. The purpose of bracing is to control the curve and slow down further progression. The brace most commonly prescribed in the clinic at Royal Manchester Children s Hospital is the Boston under arm brace. Research has shown that this needs to be worn for 16 hours per day if it is to be effective. Brace treatment is not always effective but its effect can sometimes be predicted by looking at X-rays taken in the brace shortly after it has been fitted. Surgery Surgery is generally performed when it is thought that the spinal curvature at skeletal maturity will be greater than 50 degrees. Surgery consists of straightening the spine and performing a spinal fusion operation to hold it straight. The type of surgery depends on the curve type. Before surgery a magnetic resonance (MRI) scan will be requested to examine the nerves in the spine. 6
Tips for parents Don t panic! Many advances in surgical and other kinds of treatment have been made in this field. Doctors who treat scoliosis are familiar with it and have repeatedly demonstrated high levels of success in treating scoliosis. Ask questions. You should discuss your child s problem with your Doctor. Write down questions so they are not forgotten at your child s next visit. If your child needs to wear a brace establish a daily routine for its use. This makes coping with the brace a little easier. Make a conscious effort to treat your child as normally as possible. Speak to other parents and allow your child to speak to other children with a similar condition. Your child will need support throughout treatment. For further information please contact: Scoliosis Nurse Specialist Direct Line: 0161 701 0634 Monday Friday 8.00 am - 4.00 pm Spinal Office Direct Line: 0161 701 2170/2754 Monday Friday 9.00 am - 5.00 pm Further resources Scoliosis Association (SAUK) 2 Ivebury Court 323-327 Latimer Road London W10 6RA Tel: 0208 964 1166 www.sauk.org.uk 7
No Smoking Policy The NHS has a responsibility for the nation s health. Protect yourself, patients, visitors and staff by adhering to our no smoking policy. Smoking is not permitted within any of our hospital buildings or grounds. The Manchester Stop Smoking Service can be contacted on Tel: 0161 205 5998 (www.stopsmokingmanchester.co.uk). Translation and Interpretation Service Do you have difficulty speaking or understanding English? 0161 276 6202/6342 Spinal Deformities Centre Royal Manchester Children s Hospital Oxford Road, Manchester M13 9WL Tel: 0161 701 0634 Monday Friday 8.00 am - 4.00 pm For urgent queries contact Ward 78 on 0161 701 7800 www.cmft.nhs.uk TIG 20/10 Produced January 2004 Updated January 2010 Review January 2012 (SF Taylor CM2084)