Scoliosis literally means ‘crooked’. A person with scoliosis has a curved spine. Despite the fact that a normal spine is not perfectly straight, it is still vastly different to a scoliotic spine, which curves from side to side in either a “C” or an “S” shape, often rotating as it curves. Most people first notice scoliosis because of an uneven waist or hips, dis-aligned shoulder blades, or a rib prominence on one side. Sometimes larger curves can even cause discomfort. Scoliotic curves are measured using a system called Cobb Angles, which records their sizes in degrees. As curves of 10 degrees or more are considered minor, they are merely checked regularly to monitor any progression, while curves of 20 – 40 degrees are often treated with back braces. Bracing is a treatment which cannot straighten a curved spine, but which in some cases can halt or slow down the progression of a curve, and prevent the need for more invasive treatment. Unfortunately, bracing cannot halt some curves, and if they reach 45 degrees or over and are still progressing, a spinal fusion surgery is usually recommended.
The three principal aims of surgery are: to stop the curve from progressing; to maintain and restore symmetry and balance; and to correct the curve as much as is possible. During the procedure, the surgeon uses a variety of screws and metal rods to straighten the spine and fix it in place, so that the vertebrae, packed with crushed bone, can fuse together. Currently, the most common surgical procedure is the posterior approach, which is where the incision is made down the middle of the back. This leaves a significant scar. Over the years other approaches have been tried and developed, such as the anterior approach (through the side of the ribcage or stomach) and the minimally invasive keyhole approach, which usually involves a number of small incisions down the side. Since the keyhole approach can have varying results, it is not recommended for every patient. In some cases, more than one approach is used to ensure the best result possible.
Scoliosis is sometimes associated with conditions such as spina bifida, Marfan’s Syndrome and cerebral palsy, although the majority of cases (over 80%) are idiopathic. This means that they have no known cause. People with a family history of scoliosis have an increased likelihood of developing it themselves, and girls are twice as likely to develop scoliosis and need treatment as boys. Teenagers are also more likely to get scoliosis than any other age-group. Scoliosis is not that uncommon. About three out of every 100 people have at least a mild case of scoliosis, but many will never notice it or be diagnosed.