Adolescent scoliosis

Adolescent scoliosis causes curving and rotation of the spine. The condition evolves without any identifiable cause. As a result it is known as “idiopathic” (from the Greek words idios: “one’s own” and pathos: “suffering”). Scoliosis almost always develops while a person is growing.

In many cases the curvature remains a mild one which does not need treatment. But it is important that the spine is checked every couple of months until it is no longer growing. This enables any increase in curvature to be identified and possibly treated at an early stage.

Progressive scoliosis and moderate curvature are often treated with an orthopedic brace. This can prevent the spine from becoming more curved.

Severe curvatures can make surgery necessary. An intervention involves binding several vertebrae together to straighten the spine.

Symptoms are rare with scoliosis. However, some adolescents that it affects report back pains or tensions in the shoulder area. Whether the scoliosis is really responsible for this often remains unclear, because most people without scoliosis occasionally have back pain too.

Above all, scoliosis leads to visible changes in the upper body: the back, shoulders, hips and chest can be unsymmetrical or sloping. The curvature is particularly noticeable when the person affected bends forward. The ribs then form a visible hump on one side.

With scoliosis the spine can be more or less curved. The amount of curvature is known as the Cobb angle, and it is calculated using an X-ray image.

What causes adolescent scoliosis is currently unclear. So doctors talk of adolescent, idiopathic scoliosis. Adolescent means “occurring at a young age”, and idiopathic means that there is no identifiable cause. A young age is regarded as the period between the person’s 10th birthday and when the spine stops growing.

Scoliosis has nothing to do with a poor posture that the person affected can change. In fact, adolescents who develop scoliosis can do nothing to stop it. Moreover, nothing has yet been found that can prevent scoliosis.

It is known that a disposition within the family can increase the risk of scoliosis: in approximately 10 percent of adolescents with scoliosis, the mother or father were also affected. Experts also believe that the risk of scoliosis increases if the different parts of the spine grow at different rates.

According to estimates, around 2 percent of all young people between the ages of 10 and 16 have scoliosis. In most cases, though, the spine is only slightly curved. Of those affected:

• 75 percent have mild scoliosis (Cobb angle between 10 and 20 degrees)
• 15 percent have moderate scoliosis (20 to 30 degrees)
• 5 percent have severe scoliosis (30 to 40 degrees)
• 5 percent have very severe scoliosis (over 40 degrees)

Scoliosis affects girls more often than boys. It is also very much more often more severe in girls.

With adolescent scoliosis there is no way of predicting whether the curvature of the spine will remain mild or if the curving will continue. Based on the amount of curvature (Cobb angle) and the maturity of the skeleton, however, a prediction of its evolution can be made: the more severe the curvature and the less mature the bones, the more probable it is that the scoliosis will get worse.

The maturity of the skeleton is determined using an X-ray image of the iliac crest. The more ossified the iliac crest is, the more mature the bones are. A distinction is drawn between stages 0 to 5 in this development. They are also called Risser stages. At 0 bone growth is in full progress, while at 5 it is complete.

If bone growth is complete the spine will only curve more when the scoliosis is very severe, with an angle of 50 degrees or more.

In diagnosing scoliosis in adolescents, other causes and types of spine distortion are ruled out first, as it can also be caused by legs being of different lengths. In conducting the physical examination, doctors ask particularly about:

• current symptoms
• previous illnesses
• cases of scoliosis in the family
• when the curvature was first noticed
• how it has progressed since then

They then examine the patient’s posture and anatomy.

How severe the scoliosis is, and how it might evolve in the future can be assessed via further tests. These include:

• X-ray of the spine while standing: the image shows how severe the curvature is, and it is used to calculate the Cobb angle.
• Determine the growth stage: the bone size is measured and the patient is asked whether there has been a growth surge.
• Determine the skeletal maturity: if precise details of the skeletal maturity are needed, an X-ray of the iliac crest is taken and the Risser stage is identified. This can also be done by taking an X-ray of the left hand.

There are various treatment options for scoliosis:

• Active monitoring: the spine is checked every 4 to 6 months while it is still growing. It is important to attend regular check-ups. If the curvature increases, treatment is started.
• Physiotherapy: there are specific physiotherapies for scoliosis, for example the Schroth method, which comprises stretching, posture, breathing and strengthening exercises. The exercises are intended to help the spine to straighten. However, to date there have been very few good studies of its effectiveness.
• Bracing (orthoses): orthopedic braces protect certain areas of the spine and stop the curvature from increasing. These braces are worn until the spine has finished growing.
• Operation: the surgery involves straightening the curved vertebrae using small rods, wire, hooks or screws. This intervention is only an option when the scoliosis is very severe.

There is more detailed information, for example on potential treatments for scoliosis, at gesundheitsinformation.de.

In many cases scoliosis sufferers can be treated as outpatients. If outpatient treatment is not enough, if the person’s quality of life is badly affected, or if the patient has severe symptoms, rehabilitation can be an option. In Germany there are various rehabilitation centers that offer inpatient treatment specifically for people with scoliosis. The treatment lasts for around 3 to 6 weeks. In the course of this rehabilitation, the patient is given, for example, physiotherapy, support for any psychological problems, and training, for example in using the brace.

When adolescents find out that they have scoliosis they are often worried. At this age especially, they want to belong, and not be different to everyone else because of an illness. Moreover treatment, which is often protracted, for example with a brace, can make them unsure: how will I manage a brace? What else can I wear now? How will people around me react?

Happily, scoliosis and its treatment usually have far less of an impact on friendships, hobbies and leisure activities than many people initially imagine.

However, making adjustments in everyday life can require some time and patience. For example, it can take weeks before wearing the brace becomes a routine habit – or before physiotherapy measures become a normal part of daily life.

Despite possible challenges, it should be made clear to patients that scoliosis is a condition that can be treated successfully, and that the end of the treatment can usually be predicted.

It can also be helpful to share experiences with other people of a similar age, for example via a self-help group or online.

Parents should definitely take their children’s concerns seriously and always involve them when scoliosis treatment is being discussed.