Scoliosis FAQ with Dr Paul Irvine

This week, we take some of the most frequently asked questions we have here at the clinic and put them to our founder, Dr Paul Irvine. While these quick FAQ’s are a good starting point, please keep in mind that scoliosis is a complex, 3D condition which requires a personal treatment plan designed by a scoliosis professional to treat properly.

As always, if you have you own questions, just get in touch.

 

What causes scoliosis, can anyone get Scoliosis?

Paul with Tony Betts at the 2018 SOSORT conference

There are two types of scoliosis – scoliosis in adults, which is sometimes known as “degenerative”  scoliosis and scoliosis in children.

Degenerative scoliosis is just that – the product of degeneration of the spine with age. Degenerative (also called de-novo) scoliosis is actually much more common than many people think, nearly 40% of adults over 50 will experience it.

The other main type of scoliosis is childhood scoliosis – the truth  is that we aren’t 100% sure what causes childhood scoliosis. While about 20% of cases can be attributed to an underlying condition, spinal deformity or a neurological or congenital cause, 80% of scoliosis cases are classified as “Idiopathic” scoliosis. Idiopathic literally means “without known cause”.

Having said that, researchers believe there are some common threads which may raise your risk of scoliosis.  Firstly, some studies have suggested that certain activities, such as ballet, gymnastics and dancing might predispose someone to scoliosis – One study has suggested that gymnasts are as much as 12 times more likely to develop scoliosis, for example.

Secondly, having a family member with scoliosis does seem to predispose someone to developing the condition.

 

Do genes play a part in scoliosis?

We know that individuals with a family history of scoliosis are more likely to develop scoliosis than those without – this strongly suggests that there may be a genetic cause (or contributor) to the development of scoliosis. There is research being carried out in this area at the moment, but at this time there is still insufficient evidence to make a definite conclusion.

 

How common is Scoliosis? 

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

 

Will Scoliosis go away on its own?

On this issue research is clear – scoliosis almost never resolves on its own, whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction. The exception to this rule is infantile scoliosis, which does sometimes resolve on its own – however if you suspect infantile scoliosis you should seek a professional consultation as soon as possible.

 

Does scoliosis affect males and females equally?

No. While both boys and girls can and do develop scoliosis, but 70% of cases are girls (with ballet dancers and gymnasts being 12 times more likely to be affected). My professional experience at the clinic backs this up – the majority of cases we see are females. That being said, its possible that scoliosis might be more prevalent in boys than we yet know.  Since girls are far more likely to be involved in sports such as ballet and gymnastics (where coaches now often look for scoliosis) the figures might be slightly skewed in their favour simply because scoliosis in girls is more often noticed.

 

Is scoliosis most common in young people, whose spines are still developing?

As we already mentioned, scoliosis is common in both adults and children. The cause in adults is usually spinal degeneration and is better understood.  Scoliosis in children usually starts to develop between 10 and 15, but the rate of scoliosis development increases rapidly form age 11 to 14.

 

How serious does scoliosis need to be before surgery is the only option?

When we talk about the severity of scoliosis, we consider a measurement known as cobb angle – cobb angle is simply the degree of curvature of the spine away from the normal position.

As a general rule, a cobb angle over 45 degrees will often be considered an indicator for surgery, however some braces (such as our ScoliBrace) have been shown to be effective in reducing the progression of scoliosis and improving the curve in patients up to 60 degrees cobb.

At our clinic we often combine bracing with exercise-based approaches to scoliosis treatment, such as SEAS and the Schroth method. These approaches teach patients to actively correct their scoliosis using physical therapy exercises and can be effective for treating small curves (less than 20 degrees) as a standalone treatment. That being said, many parents prefer part time, or night time bracing in these situations as exercise must be performed correctly and routinely to have a chance of success.

The latest generation of scoliosis braces are far more effective than older versions. There has been a great deal of research in the field over the last 10 years, so that today the majority of patients who wear a brace will see significant curve correction, and there is an excellent chance of complete correction of the scoliosis – especially when spotted early.

 

What is the prognosis for people with scoliosis? Can it be completely cured?

This depends mainly upon age and the severity of scoliosis. If curves are spotted early and treated before they reach 30 degrees, there is an excellent chance of avoiding surgery and it is highly likely that a complete or near complete curve correction can be achieved.

To give some numbers, studies show that 30-50% of scoliosis cases which are left untreated progress to the surgical threshold – whereas when bracing is used 70-90% will not progress and can be improved. Roughly 10% of cases will progress to surgery despite bracing.

Without a doubt, some cases will always progress even with bracing, however a significant number of the 10% of cases which do not respond to bracing will be as a result of the patient not wearing the brace for the allotted time.

In cases where bracing is not successful, surgery remains an option. At our clinic we strongly encourage people to try modern non-surgical approaches before taking the considerable step of undergoing a surgical procedure, as this comes with many risks and complications – but there is no doubt that orthopaedic surgeons can do fantastic work in treating scoliosis in cases where non-surgical approaches are not successful.

 

Does poor posture cause Scoliosis?

While many people with scoliosis might report poor posture, it is not thought that poor posture causes scoliosis. The main known factors are heredity and participation in some sporting activities, as mentioned above. There has been a small amount of research which has suggested that factors such as diet may have an impact, but far more research is needed before anything authoritative can be said in that regard.

 

Is there anything I can do to avoid scoliosis?

The best way to reduce your risk of having your life limited by scoliosis is to regularly screen for scoliosis in the first place. Scoliosis which is spotted early is much easier to treat and can almost always be prevented from developing.

There is no research which clearly indicates any positive action will reduce the chance of scoliosis developing – although avoiding ballet, gymnastics etc. might reduce risk.

Since that isn’t much fun – especially for young girls – Scoliosis screening is the best thing to do. Screening is easy to do (we even have an online screening tool people can use) with their friends or family at home – self screening takes about 5 minutes!

A great deal of research recommends screening in schools as a method for spotting scoliosis early – and most researchers agree that screening is an effective way to reduce the number of patients eventually requiring surgery. In the UK scoliosis screening is not implemented in schools, although some sports clubs (particularly ballet) do perform screening.  By contrasting example, Hong Kong offers scoliosis screening to all students.

 

Can I check if my child has scoliosis?

You certainly can, and it’s easy to do. We have an online tool called scoliscreen which you can use to perform a screening at home (try here) or you can simply follow the simple screening guidelines on this page. If you do suspect scoliosis, be sure to get a professional consultation from a scoliosis practitioner sooner rather than later. Most reputable clinics should offer this service for free.