Scoliosis is a three dimensional, rotational deformity of not only the spine, but also the whole trunk. Usually, in more than 80% of the cases, the specific cause of a scoliosis is not found and the patient is otherwise healthy, this is called ‘idiopathic scoliosis’ and occurs in 2-4% of adolescents, predominantly in girls. Other types with a known origin are called congenital (present at birth), neuromuscular (related to a neurologic or muscular disorder), syndromic (related to a bigger and more general health problem), or degenerative (related to degeneration of the intervertebral discs at a later age).
At this time, the development of scoliosis cannot be prevented. Usually it develops in a relatively short (couple of months) period of time, it is often not detected by parents in the early stages, also because no parent sees their adolescent child naked very frequently. Summer vacations with the family, with bathing suits or thin clothes, are the typical times when parents notice that their child’s back may have become asymmetrical. Often, this can be quite a shock and parents may feel that they have missed something, but it is important to know that a couple of months earlier, probably nothing could be noticed yet because the condition originates during the time that the child grows rapidly.
Nevertheless, it is important to diagnose the condition as early as possible, when non-surgical treatment can still be effective. Possible early treatment options can then be careful observation, Scoliosis Specific Exercise therapy (PSSE, Schroth therapy), or a brace. The main purpose at this stage is to prevent further deterioration of the curve, small curves at maturity are not a big concern for the rest of life. If the scoliosis is 40-50 degrees or more, surgery may be indicated, surgery nowadays can be a very reliable, safe and effective way to get a very good result with a very good functional outcome, and only a short hospital admission. Of course, if surgery is indicated, this is a shared decision between the doctor and the patient/parents, where all aspects of the procedure including benefits, but also possible risks, have to be discussed in depth. The role of the doctor is to provide information and the best possible advice, in the interest of the patient.
