Scoliosis refers to a three-dimensional structural deformity of the spine affecting approximately 0.5 – 5% of the paediatric population. Broadly speaking, there are 4 main types of paediatric scoliosis:
Idiopathic scoliosis (AIS)
Non-structural scoliosis is due to factors external to the spine. It can be caused by a length discrepancy, pain from infection, tumour, trauma or nerve root irritation. For example, pain from nerve irritation can result in a curve from muscle spasm. Non-structural scoliosis should be investigated with MRI to determine the cause.
Structural scoliosis occurs due to rotation of spinal vertebrae and manifests clinically as a rib prominence and visual spinal curvature. People with scoliosis will typically have pelvic obliquity and trunk asymmetry.
Idiopathic scoliosis is the most common form of scoliosis affecting paediatric patients. It is classified based on the age of the child at presentation. Early onset scoliosis onsets before 10 years of age. Adolescent idiopathic scoliosis (AIS) onsets after 10 years. The Cobb angle is the most widely used measurement to quantify the magnitude of spinal deformities and is measured based on plain radiographs of the spine. Scoliosis is defined as a Cobb angle greater than 10 degrees. Mild scoliosis is equally common in males and females, however, females are significantly more likely to have a curve of greater than 40 degrees. The goal of scoliosis management is to enter skeletal maturity with a balanced spine with a curve that will not progress further.
Neuromuscular scoliosis is spinal deformity that results from improper functioning of the nervous system or muscles. Diseases such as cerebral palsy, muscular dystrophy and neurofibromatosis have high rates of associated scoliosis. Many of these patients will require surgical intervention as their spinal deformity progresses.
Congenital scoliosis encompasses a spectrum of structural disorders that are present at birth, and which cause progressive deformity as a child grows.
Physiotherapists play a role in the management of all different types of scoliosis. The rest of this blog will focus on management of AIS. Broadly speaking, AIS can be treated operatively or non-operatively. Non-operative treatment consists of observation, bracing and symptomatic management. General practitioners and specialist spinal orthopaedic doctors should be involved in the care of all patients with a curve greater than 20 degrees. Surgery may be indicated for patients with curves greater than 40 degrees.
Physiotherapists help patients who have been managed operatively and non-operatively. Symptomatic management involves exercise and manual treatment to restore and maintain mobility and decrease pain. For patients who have undergone surgery, physiotherapy is an integral part of rehabilitation and return to activity. Treatment must be individualised to the patient and their symptoms.
Scoliosis is a complex condition requiring physiotherapists, medical practitioners and patients to work together to achieve optimal outcomes. Most individuals with scoliosis can benefit from physiotherapy in order to address mobility impairments, muscle strength and length deficits and pain.