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London Clinic 07776 511824
Norwich Clinic 01603 505063

The London Norwich Spine Clinic is based at
Hospital of St Johns & St Elizabeth, St Johns Wood, London
and the Spire Norwich Hospital, Norwich.
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Information for GPs

Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.

Scoliosis

Scoliosis is an abnormal rotation of the spine, bending to the left or right into an S or C shape, and the amount of curvature can vary from slight to severe.

Scoliosis usually affects young children and adolescents - a curvature can develop rapidly during growth spurts. It can also occur in elderly patients, known as degenerative scoliosis, due to wear and tear on the back.

Causes

In most scoliosis cases (about 80%), the cause is unknown. However, scoliosis can be secondary to a different condition, particularly those that affect nerves or muscles in the back such as muscular dystrophy or cerebral palsy. It can also be genetic and run in families.

Symptoms

Often the only symptoms in children are the appearance of the back:

  • Noticeable change in posture
  • Clothes hang unevenly
  • One shoulder may be higher than the other
  • One shoulder blade sticks out
  • One hip is more prominent
  • Ribs may stick out on one side (if curve is in the upper back). This is known as a rib hump.

It's more likely to cause symptoms in adults caused by the nerves in the spine being compressed, including:

  • Back pain
  • Shooting nerve pain

Diagnosis

  • Physical examination and observation
  • X-ray of the spine

The severity of the curve is measured in degrees, known as the Cobb angle.

Treatment options

Non surgical

Observation

Most cases of scoliosis are mild, with the curve of less than 20° that does not get worse. Most patients just need regular check-ups, especially during periods of rapid growth, to monitor any progression.

Bracing

In cases where the curve is more than 20° in children who have not finished growing, wearing a back brace can help. It will not correct the scoliosis but can prevent it getting worse.

Surgery

In severe cases, especially if the child is still growing, surgery may be necessary to straighten the spine. If a curve is over 40°, it is likely to progress by 0.5-1° a year after skeletal maturity, so it is easier to correct at a younger age before the deformity becomes fixed.

Spinal Fusion

This is the most common technique to treat the deformity, where the affected bones are straightened then fused (joined) together using metal rods and screws fitted to the spine.

Most patients spend between 5-10 days in hospital after the operation. Children can normally return to school after 4-8 weeks. The spine is weaker than normal for a few months while the bones continue to fuse but all everyday activities can resume after about 6 months and sport after a year.


"Now I get out a lot more, do more active things and have a lot more confidence. I am so thankful that Mr Rai was able to help me and make me so much happier with myself." Read case studies >

Case studies

Miss S, aged 13

Condition: Scoliosis

Treatment: Corrective surgery to straighten the spine using rods

Mr Rai's notes

"The importance of surveillance. Scoliosis often affects young children and it is important that they are reviewed on a regular basis to monitor their condition. Miss S presented to the scoliosis clinic at age 11 following examination by a school nurse. This first x-ray (1)shows a relatively mild curve and arrangements were made to see her regularly at 6 month intervals. The next x-ray (2) shows the progression of the scoliosis after one year. This is a significant scoliosis which would have caused problems in the future both in terms of increasing back pain and a highly visible deformity.

The decision to operate on Miss S was undertaken by a multidisciplinary team. The patient and her family were put in touch with other families who had undergone a similar operation. The operation was performed using titanium screws and rods (3) without any complication with a very pleasing result and the added advantage of Miss S gaining 2-3 inches in height. She is now leading a normal life but is reviewed in clinic on a yearly basis."

Scoliosis pre-op
1. Pre-operation
Scoliosis pre-op
2. Pre-operation
Scoliosis post-op
3. Post-operation

Miss H, aged 13

Condition: Scoliosis

Treatment: Corrective surgery to straighten the spine using rods

Mr Rai's notes

"Miss H's curvature was around 65-70 degrees and that is quite significant. This was likely to progress as she got older, by 0.5-1 degree a year which would affect her ability to lead a normal and active lifestyle."

The patient's experience:

"I first realised something was wrong when I was 12. I was lying on the floor and felt quite uncomfortable. I asked mum to have a look at my back and she said it seemed out of place.

Until that point I had a fairly normal childhood - I was healthy and had never broken any bones. Mum would often tell me to stand up straight though and I'd say 'I am standing up straight'. It was so frustrating.

I didn't find it difficult to decide to have the operation. I just wanted it put right.

When I got out of bed after the surgery, I couldn't believe how much taller I looked, about three inches, and how upright. It made such a difference.

Now I get out a lot more, do more active things and have a lot more confidence. I am so thankful that Mr Rai was able to help me and make me so much happier with myself."

X-ray of mid back