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Scoliosis in children

Published by Bupa's health information team, February 2008.

This factsheet is for parents of children with scoliosis. The type of scoliosis mainly covered in this factsheet is called idiopathic scoliosis and has no known cause.

Scoliosis is a condition in which the spine curves sideways. Many people have a slight sideways curvature in their spine, which is considered normal. Scoliosis is defined as a curve of more than 10 degrees. The curvature (the degree to which the spine has curved) can be a C-shape or S-shape, and the spine may also be rotated.

Animation - How idiopathic scoliosis occurs
About idiopathic scoliosis
Symptoms
Causes
Diagnosis
Treatment
Prevention
Living with scoliosis
Questions and answers
Related topics
Further information
Sources

How idiopathic scoliosis occurs

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About idiopathic scoliosis

Idiopathic scoliosis is quite common, affecting one to three in every 100 people. It usually develops in children between the ages of 10 and 15 during the growth spurt of puberty. This is called late onset or adolescent scoliosis. This affects nine times as many girls as boys.

Scoliosis can affect younger children and babies too. In younger children, the curvature in the spine can get worse as the child grows. This is called early onset or infantile scoliosis. The curvature is usually to the left, and slightly more boys are affected than girls.

Symptoms

Scoliosis in children usually has no symptoms until the curvature becomes severe. It's not usually painful. The first sign of scoliosis may be that your child's clothes seem to hang unevenly or you notice a change in posture.

Other signs may include one shoulder being higher than the other. The space between the body and the arms may look different on each side when your child stands with their arms at their sides. One hip may be more prominent. A curvature can develop rapidly in children during growth spurts. A small curve may become a larger curve over a relatively short period.

If the curve is in the upper back, the ribs may stick out on one side. In older girls and women, one breast may be higher than the other or appear larger than the other.

Causes

Idiopathic scoliosis

This is a type of acquired scoliosis. The cause of idiopathic scoliosis is not known - idiopathic means an illness of unknown cause. Around eight out of 10 cases of structural scoliosis are idiopathic.

The condition often seems to run in families. About three out of 10 people with scoliosis have one or more close family members with the same condition.

Illustration showing the effects of scoliosis
The effects of scoliosis

Other types of scoliosis

Non-structural or mobile scoliosis

Spine curvature, without rotation, can be caused by an underlying problem. These include:

poor posture
muscle spasm caused by a compressed or "slipped" disc perhaps
having one leg shorter than the other

Correcting the underlying problem reverses this type of scoliosis.

Structural scoliosis

Usually the underlying cause of scoliosis can't be reversed. This is called structural scoliosis or true scoliosis. If you are born with it, it's called congenital scoliosis. Or it may develop after birth which is termed acquired scoliosis.

Congenital scoliosis happens when the spine doesn't develop as it should while a baby is in the womb. For example, the bones that make up the spine (vertebrae) may grow more on one side compared with the other, resulting in curvature. This type of scoliosis can get worse over time, but the severity depends on how the spine has formed.

Causes of acquired scoliosis include:

neuromuscular scoliosis, due to a condition that affects the nerves or muscles of the back, such as cerebral palsy or muscular dystrophy
metabolic scoliosis is associated with disorders of metabolism (the production and breakdown of chemicals in the body) - this includes osteoporosis which is a loss of bone density
trauma - scoliosis can develop after an accident that damaged the spine
cancer - some types of bone cancer or cancer treatments can cause scoliosis

Diagnosis

Visit your GP if you are concerned about scoliosis. Your GP will ask about your child's symptoms and will examine them. He or she may ask you about your child's medical history. Your GP will also ask you about other family members. If the diagnosis is confirmed then your GP will usually refer your child to a spinal orthopaedic specialist.

Your doctor will do X-rays to show the position and size of the curvature. The curve is given a measurement in degrees, called Cobb's angle. The doctor can compare early X-rays with later ones to tell whether the curvature is getting worse.

Sometimes your child will also have other scans such as a CT scan or an MRI scan. A CT (computerised tomography) scan uses X-rays to make a three-dimensional picture of the body. An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the body.

Most cases of scoliosis are mild and your child will just need regular check-ups to monitor the curvature. These check-ups will probably be every four to six months.

Only one in 10 children with the condition needs to have treatment for scoliosis.

To check for scoliosis, ask your child to bend forward from the waist, with the palms of his or her hands together. The ribs will stick up more on one side causing a bulge in the back if he/she has scoliosis.

Illustration showing the scoliosis back bend test
The scoliosis back bend test

Treatment

Braces

Your child's doctor may recommend a back brace if the curve is more than 20 degrees. You should discuss this treatment option thoroughly with your child's doctor. The aim of the brace is to stop the curve getting worse. Various types of brace are available and these often need to be worn for up to 23 hours a day.

The medical evidence for how well braces work is mixed, but they are likely to be more effective when treatment is started younger, while the back is still growing. Braces are usually worn until your child stops growing.

Your child may feel embarrassed and might find wearing a brace difficult and uncomfortable at first. Family support is crucial, and there are also support groups you can get in touch with (see Further information). Talking to other children or teenagers who are going through the same thing may help.

Surgery

Depending on the degree of curvature, your child's doctor may recommend surgery. Surgery aims to reduce the amount of curvature of the spine and prevent it from getting worse.

The most common technique is spinal fusion, in which the affected bones of the spine are straightened and then fused (joined) together. The curvature is largely corrected by metal rods and locks fitted to the spine.

Spinal fusion is a commonly performed and generally safe surgical procedure. For most people, the benefits are greater than the disadvantages. However, in order to make a well-informed decision and give your consent for your child to have the operation, you need to be aware of the possible side-effects and the risk of complications. Your child's surgeon will discuss these with you.

Other treatments

Other treatments for scoliosis include exercises and electrical stimulation. There is little medical evidence to say that these are effective.

Prevention

There is no way to prevent structural scoliosis. Early detection and treatment, if necessary, helps to prevent the curvature getting worse.

Check your children regularly for scoliosis from the age of nine throughout their teens if you have a history of scoliosis in your family. All newborn children are checked for the rare infantile type as part of a routine postnatal check-up.

Living with scoliosis

Idiopathic scoliosis doesn't cause any life-threatening problems, but it can make life difficult. As the curvature gets worse, the spinal bones (vertebrae) tend to rotate. This rotates the ribs, reducing the space in the rib cage and making it harder to breathe properly. This is only a problem for severe curvature, over 60 degrees.

Severe curvature can also restrict movement. The earlier scoliosis begins and the higher up the back the curve is, the worse the curvature.

Scoliosis won't cause major physical complications, but having spinal curvature can affect his/her body image and confidence. So it's important that your child gets enough emotional support. This can include support from family and friends, or from patient groups (please see Further information).