Scoliosis

Royal Manchester Children’s Hospital
Scoliosis
Information For Parents and Carers

What is scoliosis?
Scoliosis is a lateral (sideways) curvature of the spine. It can be
due to abnormalities in the legs but is most commonly due to
a problem in the spine. It usually develops during early
adolescence. In most cases the curve is slight but in severe
cases the spine can become ‘C’ or ‘S’ shaped.
A normal spine appears curved when viewed from the side and
straight when viewed from behind. In scoliosis, the opposite is
true, that is the spine appears straight when viewed from the
side yet curved when viewed from behind.
Facts about scoliosis
• 1 in 20 people has scoliosis generally in a very mild form.
• Of these 1 in 20, five percent, will have a more severe
spinal curvature.
• Scoliosis is generally not painful in young people but can
become painful in adults.
• Scoliosis is treated most successfully when the patient is
younger. The body can respond better to treatment while it
is still growing.
• Scoliosis may increase during growth periods. Larger curves
may continue to progress during adult life.
Signs of scoliosis
• One shoulder may be higher than the other.
• One shoulder blade may be higher and more prominent.
• One hip may be more prominent than the other.
• Clothes may not ‘hang right’ – it is often difficult to get a
hem to hang level or trousers to appear the same length.
• Girls may complain that one breast appears less prominent
than the other.
3

What causes scoliosis?
Eighty percent of scoliosis is of unknown cause (idiopathic).
Much research is being done into this field including work at
the Royal Manchester Children’s Hospital. In most of these cases
the condition develops in girls between 10 –15 years old and is
more common in the relatives of those affected.
Other cases are congenital (caused by abnormal development
of the bones in the spine) and some are due to problems with
nerves or muscles (such as cerebral palsy or muscular dystrophy).
How is scoliosis detected?
Scoliosis can be seen by a trained observer looking at a patient’s
back. When a patient bends forward one side of the chest or
loin may appear more prominent if scoliosis is present.
Some education authorities screen all teenagers for scoliosis.
If the school doctor has any doubts then an appointment is
usually arranged at the scoliosis clinic for X-rays to be taken.
Monitoring and progression of the curve
Although some new photographic methods are now becoming
available, X-rays are still the most reliable way of detecting any
worsening in the degree of scoliosis.
At the time of diagnosis there is no accurate way to predict
which curves will worsen. Some smaller curves do not get
worse. Many curves remain stable for years but suddenly get
worse during the adolescent growth spurt. The child’s potential
for growth is therefore one of the most important factors in
predicting curve progression. In general, patients who have a
lot of growth to come have a higher risk of curve progression.
Growth potential, and therefore potential for curve
progression, can be evaluated by age at diagnosis, menstrual
history and radiological signs of bone maturity. Overall, females
with scoliosis have a greater risk of curve progression.
4

Treatment
Scoliosis is treated to prevent curve progression and also
to preserve good appearance. There are three main types
of treatment/care:
• Observation
• Bracing and casting
• Surgery
Observation
Patients with a recently diagnosed mild curve are observed
for a period of time to determine if the curve will progress.
Since most curves do not become severe, observation is often
all that is required. This enables the Surgeon to plan any active
treatment that may be necessary.
The most accurate method of observation is to perform a
standing X-ray. Each X-ray is compared with the previous one
to determine the amount of curve progression. Generally those
with mild curves are seen in clinic every six months but those
with larger curves will be seen every three to four months,
especially if the child is growing rapidly.
5

Bracing
Bracing maybe used when the child is growing rapidly and the
curve is between 20 and 30 degrees. The purpose of bracing is
to control the curve and slow down further progression.
The brace most commonly prescribed in the clinic at Royal
Manchester Children’s Hospital is the Boston under arm brace.
Research has shown that this needs to be worn for 16 hours
per day if it is to be effective.
Brace treatment is not always effective but its effect can
sometimes be predicted by looking at X-rays taken in the
brace shortly after it has been fitted.
Surgery
Surgery is generally performed when it is thought that the
spinal curvature at skeletal maturity will be greater than 50
degrees. Surgery consists of straightening the spine and
performing a spinal fusion operation to hold it straight.
The type of surgery depends on the curve type.
Before surgery a magnetic resonance (MRI) scan will be
requested to examine the nerves in the spine.
6

Tips for parents
• Don’t panic! Many advances in surgical and other kinds
of treatment have been made in this field. Doctors who
treat scoliosis are familiar with it and have repeatedly
demonstrated high levels of success in treating scoliosis.
• Ask questions. You should discuss your child’s problem with
your Doctor. Write down questions so they are not
forgotten at your child’s next visit.
• If your child needs to wear a brace establish a daily routine
for its use. This makes coping with the brace a little easier.
• Make a conscious effort to treat your child as normally
as possible.
• Speak to other parents and allow your child to speak to
other children with a similar condition. Your child will need
support throughout treatment.
For further information please contact:
Scoliosis Nurse Specialist
Direct Line: 0161 701 0634
Monday – Friday 8.00 am - 4.00 pm
Spinal Office
Direct Line: 0161 701 2170/2754
Monday – Friday 9.00 am - 5.00 pm
Further resources
Scoliosis Association (SAUK)
2 Ivebury Court
323-327 Latimer Road
London W10 6RA
Tel: 0208 964 1166
www.sauk.org.uk
7

No Smoking Policy
The NHS has a responsibility for the nation’s health.
Protect yourself, patients, visitors and staff by adhering to our
no smoking policy. Smoking is not permitted within any of our
hospital buildings or grounds.
The Manchester Stop Smoking Service can be contacted on
Tel: 0161 205 5998 (www.stopsmokingmanchester.co.uk).
Translation and Interpretation Service
Do you have difficulty speaking or understanding English?
☎ 0161 276 6202/6342
Spinal Deformities Centre
Royal Manchester Children’s Hospital
Oxford Road, Manchester M13 9WL
Tel: 0161 701 0634 Monday – Friday 8.00 am - 4.00 pm
For urgent queries contact Ward 78 on 0161 701 7800
www.cmft.nhs.uk
TIG 20/10 Produced January 2004 Updated January 2010 Review January 2012 (SF Taylor CM2084)