The spine has natural curves from front to back but it shouldn’t curve sideways. A side-to-side curve is called scoliosis and may take the shape of an abnormal ‘S’ (double curve) or a long ‘C’ (single curve). The scoliotic spine is also rotated or twisted pulling the ribs along with it to form a multi-dimensional curve. In serious cases, lung and heart function can be affected as well as other organ systems.
Scoliosis can develop at any age but is most common in children aged 10-15. In the UK, around three or four in every 1,000 children need treatment for scoliosis.
It's more common in females than males.
Congenital scoliosis is a type of scoliosis that you are born with.
It happens because the vertebrae do not form as they should while a baby is growing in the womb. Vertebrae are the small bones that make up the spine and some of these might be missing, or some might not have formed fully, which can cause the spine to curve as it grows. This can start to happen in the first 6 weeks of pregnancy, but why it happens is not fully understood. Most causes of congenital scoliosis do not seem to run in families.
Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal.
Everyone has some degree of curvature in their spine. However, a curve of more than 45 degrees is considered excessive.
Sometimes kyphosis doesn't cause any symptoms other than the back appearing abnormally curved or hunched. This can be flexible but over time become fixed if a child can not move out of it, for example if they have neuromuscular disease.
The difference between kyphosis and scoliosis is that kyphosis is a forward curvature of the spine, giving the appearance of a hunchback. Scoliosis is a lateral curvature in which the spine curves to the side in either direction.
Scheuermann’s disease (Scheuermann's kyphosis)
Scheuermann's disease is a developmental condition in which the front sections of the vertebrae (small bones that make up the spine) grow more slowly than the back sections during childhood.
This difference in growth means the vertebrae grow into the shape of a wedge, when they should grow into the shape of a rectangle. These wedge-shaped bones don’t stack up in a straight line. As a result the spine develops a forward angle as it grows. The forward bend of the spine is called kyphosis
The curve usually happens during a time when the bones are growing very quickly. Often this is between age 10 and 15 but for some patients it worsens when they are adults.
Patients with Scheuermann's kyphosis often have back pain, especially during the early teenage years. This pain usually decreases when a person gets closer to adulthood.
Idiopathic scoliosis is a change in the shape of the spine during the child’s growth. It results in the spine curving sideways and twisting at the same time. This twisting can pull the ribcage out of position, often leading to a hump on one side of the ribs. When this happens between ages 10 and 18 it is called adolescent idiopathic scoliosis (AIS).
The word idiopathic means there is no known cause.
Early Onset Scoliosis
Early Onset Scoliosis (EOS) a term used to describe a spectrum of spinal disorders ranging from idiopathic (cause unknown) or congenital (born with scoliosis) to syndromic (associated with other conditions) and neuromuscular (Cerebral palsy). These disorders occur under the age of 10. As scoliosis affects the curvature of the spine it also affects the ribcage and therefore can impact on heart and lung function which if untreated can shorten the life span in adulthood.
Treatment is aimed at:
- Minimising spinal deformity and the complications caused by spinal scoliosis
- Maximising the movement of the chest wall
- Minimising the impact on the child’s everyday level of function and their wellbeing
Treatment options may include the use of plaster jackets or braces and in severe cases surgery may be required. Due to the life changing consequences of this condition it is important to start treatment as soon as possible.
Neuromuscular scoliosis is a curvature of the spine caused by a neurological or muscular condition. Neurological conditions such as cerebral palsy and spina bifida affect the body’s nervous system. They happen when there is damage to the brain or nerves caused by illness or injury. They can affect the muscle-nerve pathways of the body from the brain down to the spinal cord
Muscular conditions such as Duchenne muscular dystrophy or spinal muscular atrophy stop the muscles from working. When the muscles do not work, scoliosis can develop.
Patients with these conditions often develop scoliosis or kyphosis, or both. As they grow and their trunk muscles get weaker, the spine gradually begins to collapse, which creates a long, C-shaped collapsing scoliosis.
How Physiotherapy can help
Physiotherapy can help in the management of postural scoliosis and kyphosis with advice, exercise and other treatments if the child is in pain.
If surgery is required, our physiotherapists are involved in the pre-operative assessment. This helps to ensure the child is prepared for surgery and understands what they will need to do after surgery. The physiotherapist will also record the child’s range of movement, muscle length and walking pattern. A lung function test may also be required to record the lung capacity.
Following surgery, a physiotherapist will help with getting out bed, mobilising and teaching exercises for breathing and muscle control. Following spinal surgery, physiotherapy rehabilitation is tailored to the individual’s needs.
For more information about The Portland Hospital’s spinal surgeons or to arrange an appointment please contact our Children's Enquiry Line on+44 (0)20 7390 8020.