Definition Scoliosis is a condition in which the spine is bent to one side. It can occur in infants and children, but typically develops during adolescence, when growth is most rapid.
What is going on in the body? The vertebrae, or bones that form the spine, are usually aligned straight when viewed from behind. In scoliosis, the spine is bent to the side. The spine can sometimes rotate, causing an uneven rib cage. If this happens, the ribs in the back will be prominent on one side. Scoliosis is sometimes associated with excess bending forward of the spine, called kyphosis, or excess bending backward of the spine called lordosis. The curve of the spine may vary from a C-shaped to a S-shaped pattern.
What are the signs and symptoms of the condition? The person usually experiences no symptoms, except in rare cases such as the presence of a tumour or infection. The following signs may be observed:
visible curves of the spine
forward bending with a rib "hump" visible from behind
uneven pelvis
one side of pelvis more prominent
one shoulder higher than the other in moderate to severe cases
What are the causes and risks of the condition? Scoliosis may be inborn or developmental. The cause is usually unknown. Severe cases are seen more frequently in girls than in boys. Scoliosis is also more common when there is a family history of scoliosis. Scoliosis may be the result of:
malformed vertebrae
disease of the nervous or muscular systems
tumour of the vertebrae or spinal cord
infection
fracture
What can be done to prevent the condition? There is no way to prevent this condition.
How is the condition diagnosed? Scoliosis is diagnosed based on the signs listed above. X-rays demonstrate the degree of scoliosis when special measurements are made of the X-ray films. X-rays may also reveal the cause of the curvature. An instrument called an inclinometre measures the amount of rotation of the rib cage.
What are the long-term effects of the condition? Mild to moderate scoliosis may not cause any problems. More severe scoliosis may cause pain. In advanced cases where the rib cage or chest is badly rotated, breathing may be difficult.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? Observation is appropriate for many mild curves that do not progress. Braces may be used for moderate curves that are progressing, but are not always effective. Finally, a spinal fusion operation is recommended for severe, progressive curves. This operation tries to correct the curvature, at least partially. It also fuses or joins together the vertebrae of the curve, usually with metal rods or cables in the back. Scoliosis caused by nervous or muscular system conditions is more likely to progress and require an operation.
What are the side effects of the treatments? Braces may cause skin irritation. They may also cause the self-conscious teenager to not wear the brace, which can reduce its effectiveness. Surgery carries a risk of bleeding, infection, and even death.
What happens after treatment for the condition? There may be possible progression of the curve despite appropriate treatment. In rare cases following operation, the spine may not fuse successfully. This may eventually cause nerve damage with paralysis. In addition, the metal rods or cables in the spine may break, causing the need for replacement or removal.
How is the condition monitored? Parents might observe their children's exposed backs. The doctor should be consulted if a rib hump develops, the back seems out of balance, or one side of the pelvis seems more prominent.
Author: John A.K. Davies, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
