Recognising scoliosis in adolescents at an early stage

Lya is twelve when she is diagnosed with severe scoliosis. At this point, her spine is already curved by more than 55 degrees. The diagnosis was more or less an accidental finding at the GP. Until then, the schoolgirl from Düdingen FR had had no complaints worth mentioning. And because Lya had always been slim, flexible and active, her mother had not been seriously worried.

Unfortunately, Carol Hasler, Head of Orthopaedics at the University Children's Hospital Basel UKBB, sees cases like this time and time again. «At around 90 per cent, adolescent idiopathic scoliosis (AIS) is by far the most common form of scoliosis,» says Hasler. «It affects around one in 200 children or teenagers in this country - girls about four times more often than boys.»

This form of scoliosis is called «adolescent» because it develops during the strong growth spurts of puberty. «In girls, these begin around one to two years before the first menstrual period, in boys one to two years before the voice breaks, and end around three years after that - roughly between the ages of 10 and 16,» says Hasler. Adolescent scoliosis is also called «idiopathic» because the causes of the disease are still largely unknown.

Read the full text and find out how to recognise scoliosis at an early stage.

Not every hunched back is scoliosis

A slight lateral shift in the spinal axis or a slightly too flat or too pronounced S-curve is very common and is normal in most cases. «We have not all grown completely symmetrically,» says Hasler. This applies to the arms and legs, the sides of the face, the ribcage and also the spine.

«We therefore only speak of true scoliosis when there is a three-dimensional curvature of the spine with a Cobb angle of more than 10 degrees,» explains Hasler. The so-called Cobb angle indicates the degree of curvature in scoliosis and therefore also the severity of the spinal disorder.

It can affect any young person

During strong growth spurts, this angle can increase rapidly. «An increase of 20 to 30 degrees is possible within six months,» says Hasler. «It is now assumed that AIS is a type of growth problem in which the anterior part of the spine grows faster than the posterior part,» says Hasler. «This results in the typical changes with lateral axial displacement and twisted vertebrae.»

Genetics seems to play a certain role, but it is not the only factor responsible for the curvature of the spine.

It is not yet clear why spinal growth is uneven in some adolescents. A certain genetic component has been identified. «Children whose parents or siblings already have scoliosis have a tenfold increased risk of also developing the condition,» explains Hasler. «Conversely, 90 per cent of children with a family history of scoliosis remain healthy.» Genetics therefore appears to play a certain role, but is by no means the only factor responsible for spinal curvature.

How does scoliosis manifest itself?

Scoliosis is not easily recognisable from the outside, and even those affected often only notice changes when they are very advanced. «This is because scoliosis itself doesn't hurt at first,» says Hasler. Typical asymmetries in the torso, pelvis and shoulder blades caused by scoliosis are usually only noticeable when the child or young person has stripped down to their underwear and is standing «straight as a tin soldier» in front of you.

«Effective non-surgical treatment is only possible while the spine is still growing,» says scoliosis specialist Carol Hasler.

However, most parents rarely see their children without clothes from puberty onwards and selfies in front of the mirror are mostly taken in dynamic positions and certainly not from behind. In addition, children with scoliosis are paradoxically perceived from the outside as being particularly upright. «This is because when the front part - i.e. the thoracic vertebrae - grows faster, the upper S-curve flattens and the upper back straightens,» says Hasler.

«Although back examinations are also part of medical check-ups and screenings, these are often no longer reliably recognised during puberty. And even if they are, the intervals are often long, meaning that developmental spurts can also be missed.»

Unfortunately, there are still far too many cases of adolescent scoliosis that are only discovered late or even too late. «This is because effective non-surgical treatment is unfortunately only possible while the spine is still growing,» says Hasler. As soon as longitudinal growth is complete around the 16th birthday, there is usually not much that can be done without surgery.

Later in adult life, there is a risk of restricted movement and back pain due to tilted vertebrae, muscles strained on one side, shortened tendons and ligaments. It also frequently leads to pain in the head, shoulder and neck area as well as severe tension headaches. In addition, the risk of premature wear and tear of the vertebral bodies and intervertebral discs increases.

In very severe cases, internal organs can also become constricted, resulting in reduced lung and heart function. In addition to the health complaints, cosmetic problems are also common. In some cases, the torso and chest area are deformed. «In women, this can lead to visual changes in volume and asymmetry of the breasts, which also causes a great deal of suffering,» says the scoliosis expert.

A test for laypeople

To prevent this, it is important to recognise scoliosis as early as possible. However, as no one can predict if and when a spinal curvature will develop, the only option is to monitor it as closely as possible. With the Adam's test (see blue box), parents, grandparents or other medical laypersons also have the opportunity to recognise abnormalities in the spine very easily, quickly and reliably. Hasler advises carrying out the pre-test approximately every six months from the age of 10.

The first point of contact if scoliosis is suspected is the paediatrician or family doctor. «If the suspicion is confirmed, the child or adolescent should be referred to a centre for scoliosis if possible,» recommends the back specialist. «X-rays are then usually taken there, the exact Cobb angle and thus the severity of the deviation are determined and the remaining growth potential of the spine is ascertained.»

The treatment depends on the severity

«In the case of mild scoliosis with a Cobb angle of less than 20 degrees, it is usually sufficient to strengthen trunk stability with the help of physiotherapy and carefully monitor the further progression,» explains Hasler. If the Cobb angle is already above 20 to 25 degrees, a corset is usually also prescribed. This is a customised orthosis that prevents the spinal curvature from increasing further.

«The effectiveness of brace therapy has been proven in studies, but the orthosis must be worn for at least 18 hours a day until spinal growth is complete,» says the paediatric orthopaedic surgeon.

Not cured, but the curvature stopped

In the case of severe scoliosis with a Cobb angle of over 40 to 45 degrees, surgery may also be necessary. «During this complex procedure, the misaligned vertebrae are brought back into the correct position and fixed with screws, hooks and rods.»

Even if scoliosis is discovered during the growth phase, a complete cure is not always possible. This was also the case for Lya. «As my scoliosis was already very advanced when it was discovered and I wasn't growing for much longer, the main aim was to stop the curvature of my spine,» explains the now 20-year-old. «To do this, I started brace treatment and decided against back surgery for the time being.»

The then 12-year-old wore the orthosis for over a year and almost around the clock. «Sure, it's kind of a foreign body and a bit uncomfortable, but I knew that it was necessary and that I would get rid of the brace at some point,» says Lya. And it was worth it. Her spine has not become any more curved. Disciplined back training, regular exercise and massages still help Lya to keep it that way for as long as possible.