Scoliosis in infants
Detection
Bracing
Surgery
Alternative treatment
Genetic research

Scoliosis is defined as a lateral curvature of the spine, the presence of which is abnormal. We know that as early as 500 years BC Hippocrates was writing about it, and its name is derived from the Greek word for curvature. It can be disfiguring because when the spine bends to the side, the vertebrae (the individual bones that make up the spine) become twisted and pull the ribs round with them, which sometimes form a "bulge" on the back and cause the shoulder blade to stick out. 

The causes of scoliosis are many, and although we well understand the consequences, the origins of this condition remain complex and obscure. There are two main types of scoliosis—namely, idiopathic (no known cause) and syndromic (the curvature is part of a recognised disease pattern, such as Marfan's syndrome). Idiopathic scoliosis accounts for most spinal curvatures and they may either be of early onset, before age seven years, or late onset, after that age and usually in adolescence. There is a definite genetic connection, with around 25% of those with a scoliosis have a direct relative with a curvature. 80% of adolescence idiopathic scoliosis arises in girls, and 80% of these girls have their rib prominence on the right side.

The spine can bend towards either side of the body at any place, in the chest area (thoracic scoliosis), in the lower part of the back (lumbar), or above and below these areas (thoracolumbar). It can even bend twice, causing an S-shaped curve. When the curve is S-shaped (double curvature) it is often not noticeable and the person can appear quite straight because the two curves counteract each other. If the curve is low down in the spine, the ribs will not be affected but one hip may be higher than the other.

Scoliosis is, surprisingly, quite common. About three or four children per thousand of the general population will need specialist supervision, and about one child in every thousand will need hospital treatment usually for major corrective surgery with the insertion of a (permanent) metal rod, sometimes followed by a period in a plaster jacket or brace. Scoliosis can develop at any time during childhood and adolescence. It might develop in infancy, in which case there is a good chance of it resolving with growth. Progressive (worsening) early onset curvatures are potentially serious, and some of these may need surgical treatment. Late onset scoliosis is less serious, but some will need surgery and all need to be seen by a scoliosis specialist who can keep an eye on the situation and give some idea about the future.  Severe deformity, which is uncommon nowadays because of modern treatment, can lead to damaged lung function, or disability in middle age. The lungs are usually affected only in people with untreated early onset thoracic scoliosis, when the upper (chest) part of the spine is curved.

A developmental disorder, scoliosis is rarely present at birth. It can develop in infancy or early childhood and it is sometimes caused by rare childhood disorders. However, it is most common in early teenage years, when—especially at the start of the adolescent growth spurt—it can progress rapidly. Treatment at this age is usually corrective surgery. The psychological trauma some teenagers experience can have serious and long lasting effects.

There is contradictory evidence as to whether early discovery and treatment of a curve improves the long-term outcome, but we know that if curves are discovered too late—when they are already severe—the results of surgery can be compromised. Therefore, awareness of scoliosis and what it can mean for an individual among General Practitioners and physical education teachers in schools is regarded as important, so that early referral to a specialist in scoliosis is achieved. Treatment in a scoliosis centre will usually prevent unsatisfactory long-term results.