Spinal Team
Scoliosis
C o n ta c t
D e ta i l s
Spinal Team
Nuffield Orthopaedic Centre
Windmill Road
Headington
Oxford
OX3 7LD
Phone:
Fax:
Web Site
01865 738051
01865 738027
www.noc.nhs.uk
Scoliosis Patient Information version 1
© 2007 Nuffield Orthopaedic Centre
Spinal Improvement Group Jan 2007
Review Jan 2008
Your diagnosis
Structure of the Back
Your spine is one of the strongest parts of your body. It is made
of solid bony blocks (vertebrae) jointed by discs to give it
strength and flexibility. It is reinforced by strong ligaments and
surrounded by large powerful muscles that protect it.
Where can I find more information?
The spinal cord is the part of the nervous system which lies
within the spine and is protected by it. Nerves branch out from
the cord and carry messages to and from the brain.
What is a Scoliosis?
If you look at people from behind, their spines are mostly
straight. A few people however, have a spine which curves. This
is a scoliosis. The curve can be in one small area of the spine or
can affect the whole spine.
www.scoliosis.org – National Scoliosis Foundation
www.srs.org
– Scoliosis Research Society
www.sauk.org.uk – The Scoliosis Association (UK)
Causes of Scoliosis
For most people (80%) who have a scoliosis a specific cause is
not found (idiopathic scoliosis). The people with this type of
scoliosis are mostly female. It typically develops between the
ages of 10-16.
Some people are born with a scoliosis as a result of abnormal
bone growth during development (congenital scoliosis). Other
people have a neurological disorder which then causes a scoliosis.
Scoliosis does not come from carrying heavy things, athletic
involvement, sleeping/standing postures, or minor lower limb
length inequality.
1
USEFUL TELEPHONE NUMBERS
NOC Main Switchboard
- 01865 741155
Spinal Secretaries
- 01865 738051
Patient Advice & Liaison Service (PALS)
- 01865 738126
10
Surgery
The decision as to whether surgery should be advised is always
taken on an individual basis after discussion between the individual and the scoliosis specialist. Surgery may be recommended if:
•
•
•
your curve has increased in size
taking a deep breath is difficult because of your curve
pain.
Diagnosis of Scoliosis
As part of your assessment you will be asked to stand and bend forwards with your knees straight. If you have a scoliosis it is more
obvious in this position because the ribs are not symmetrical.
X Rays (pictures of your bones) are commonly used in scoliosis as
the size of the curve can be measured on the X-ray.
Benefits:
Surgery aims to:
•
reduce the size of the scoliosis, by rearranging the bones
and holding them in place with screws and other pieces of
bone.
•
stop the scoliosis from getting larger.
Risks:
Unfortunately, as with all operations, although every effort is
made to avoid complications, scoliosis surgery carries important
risks. Some of these are mentioned below:
1. Blood loss during surgery.
2. Damage to a nerve happens in less than 1 person out of 100.
3. In 10 out of 100 people the metal screws can cause a problem
and they need to be removed again.
4. Infection is always a risk with an operation. This affects
around 1 in 100 people. Antibiotics are commonly used to
prevent this.
5. Dural tear (a tear to the membrane around the spinal cord).
Return to activity
This is a major operation. Despite this you can get back to light
work or your studies within three months. If you are at school,
you can return to this after 1 month. You can gradually return to
all normal activities over the space of one year. Contact sports
should be avoided for 1 year after the operation but you can start
gentle exercise such as swimming after 3 months.
9
How noticeable is scoliosis?
Scoliosis tends to be noticed more by the individual than by other
people.
Prognosis
On the whole people with scoliosis do not get any more back pain
than people with straight backs.
If the curve is mild or moderate ( <30°) when you stop growing
(around age 18-20) it will probably not get any bigger as you get
older. If the curve is quite large ( >30°), the curve may continue to
get bigger as you get older.
2
Treatments for Scoliosis
If the scoliosis is mild no treatment will be necessary.
If the scoliosis is larger and you are still growing then a health
care clinician will review you regularly. Once you have stopped
growing a hospital review will only be required if the curve gets
bigger or is painful.
Treatment options for medium or large scoliosis are:
1. Exercise
2. Bracing
3. Surgery
Brace
Braces are designed to encourage the bones in your back to grow
in the correct direction and not in a curve. They work best for
people with medium size curves (between 20 – 45 degrees) who
are still growing and their curves are getting bigger. Braces are
not very useful if the curve is large or if you are over the age of
18.
The braces fit like a vest which is made of plastic. They are often
moulded to your body and padded so that they don’t rub. The
brace can be worn underneath your clothes. Your consultant will
advise you on how often to wear it. You will probably need to
wear this jacket until your bones are mature which is approximately when you are 16 or 17 years old.
The health care clinician will advise you on the best treatments
for your scoliosis.
Manual therapies
What sort of exercises should I be doing?
There is no reliable evidence that manual therapies that can be
part of osteopathy, chiropractic, physiotherapy, reflexology or
acupuncture treatments can change the structure of a scoliosis.
It is important to keep fit. Any exercise is good for scoliosis, but
stretching and strengthening exercises for the spine are the most
useful. Some exercises can be given to you with this booklet. A
physiotherapist could help you to tailor an exercise programme to
your needs if you would like this. Ask your Consultant how you
can be referred to a physiotherapist.
Should I stop doing anything?
No. There is no need to restrict activity because of your scoliosis.
You can lead a perfectly normal life with a scoliosis so keep doing all your favourite sports and activities.
3
8
Strengthening exercises
Sit down then stand up repeatedly without
using your arms.
Stretching exercises
To maintain/improve forward bending of the spine
Lying on your back
Use your hands to pull your knees
towards your chest
To improve the arm muscles
Standing
Kneeling on all fours
With one arm lift a weight above
your head
(e.g. bottle of water or a tin can)
Arch your back
Repeat on the other side
To maintain/improve backward bending of the spine
To improve your general fitness
Kneeling on all fours
Hollow your back
Lying on your front
Lean on your elbows
Cycling
7
Brisk walking
Jogging
4
Stretching exercises
Strengthening exercises
To maintain/improve side bending of the spine
To improve the trunk muscles
Lying on your back
Lying on your back
Make one leg longer
Tighten the tummy
Repeat on the other side
Lift the head and shoulders
Standing
Lying on your front
Stretch your arm above your head
Put your hands above your head
Lean over to the side
Lift your hands and shoulders upwards
Repeat to the other side
To maintain/improve hip and hamstring mobility
Lying on your back
Standing
Lift one leg towards the opposite arm
Use your hands to bend one
knee towards your chest
Repeat on the opposite side
Repeat on the other side
Standing
Step on and off a step
Lying on your back
Place your hands behind one
knee
Gently straighten the leg
Repeat on the other side
5
To improve the leg muscles
Change to leading with the opposite leg
Lean over a stable surface at hip
height
Lift one leg backwards
6