Spine Clinic: Diagnostic & Interventional Spinal Care

Diagnostic & Interventional Spine Clinic Consultants

Scoliosis treatment at Vale Healthcare's Spine Centre

Vale Healthcare's Scoliosis treatment centre is the only private facility in Wales, treating patients with scoliosis from 3 years of age. Spinal Consultants at Vale Healthcare include both Mr Paul Rhys Davies and Mr Stuart James, both specialising in the assessment and treatment of Scoliosis.

Mr Paul Rhys Davies has more than 15 years of experience in treating children and adolescents with scoliosis and is the senior member of the scoliosis unit in Cardiff (with Cardiff as the third biggest scoliosis unit in the UK). Surgery on our patients is usually carried out jointly by both Mr Davies and Mr James which is best practice for these complex cases, resulting in what we believe is the best and safest result for your child.

Consultations and assessment for this condition take place at both The Vale Hospitaland the Cardiff Bay Clinic. Rapid access appointments are available, with immediate access to on-site X-ray and MRI facilities enabling instant access to diagnostic imaging facilities. This access allows consultants to refer for any necessary scans with instant reporting, helping to make any visits to the hospital or clinic as stress-free and comfortable as possible.

Any surgical treatment for scoliosis would take place at The Vale Hospital, located in Hensol (in the Vale of Glamorgan).Additional to the hospital's state of the art facilities for consultation and diagnosis, are the two digitial operating theatres with laminar flow. The theatres are custom built to meet the highest standards for infection control, and are the most advanced of their kind in the UK.

The Vale Hospital has 25 private bedrooms with en-suite, including specially designed parent and child bedrooms, enabling parents to stay with their children throughout their recovery post-surgery. The hospital is situated within a rural parkland estate, adjacent to Hensol Lake, providing a calm and relaxing environment for recovering after any procedure.

What is Scoliosis?

Scoliosis is defined as an abnormal curvature curve in the spine, of more than 10 degrees. The spine may be a C-shape or S-shape, and may also be rotated (twisted).Curvature of the spine can occur at any point, from the top to the bottom. However, the most common regions affected are:

The chest area (thoracic scoliosis)
The lower back (lumbar scoliosis)

If scoliosis is left untreated, the curvature of the spine can get worse and cause damage to the spine, chest, pelvis, heart, and lungs.

There are two types of scoliosis:

Non-structural (mobile) scoliosis. Often caused by a condition outside the spine, which disappears when that is corrected. For example, if one of your legs is longer than the other, the curvature in your spine will disappear when you sit down.
Structural (true) scoliosis: A fixed curvature in your spine. Usually the underlying cause of structural scoliosis can't be treated.

Causes of Scoliosis

There are several causes of scoliosis…

Idiopathic

Idiopathic scoliosis is fairly common (affecting 2-3 out of every 100 people), with the condition usually developing between 10-15 years of age (known as ‘late onset’ / ‘adolescent idiopathic scoliosis’). The condition is not present at birth and the cause is unknown. Idiopathic scoliosis almost always results in curvature to the right, and is more common in girls.

Less commonly idiopathic scoliosis occurs in younger children, known as ‘early onset scoliosis. The curvature is usually to the left, and is slightly more common in boys. There seems to be a family link with idiopathic scoliosis, with approximately 3 in 10 people with scoliosis having one or more family members with the same condition.

Idiopathic scoliosis is a type of structural scoliosis or true scoliosis. This means that the underlying cause of the scoliosis cannot be reversed.

Congenital

Congenital scoliosis is where you are born with an abnormally curved spine. This is caused by development of the vertebrae that is not symmetrical. Sometimes two of the vertebrae are joined together on one side, and a person’s spine becomes curved as the individual grows. This is usually quite apparent before adolescence.

Neuromuscular

This type of scoliosis is caused by conditions affecting the nerves / muscles of the back, such as cerebral palsy or muscular dystrophy. Neuromuscular scoliosis can be structural or non-structural, depending if there is rotation of the spine (in addition to any curvature). Non-structural scoliosis can be caused by several problems including:

poor posture
muscle spasm eg caused by a compressed or 'slipped' disc
having one leg shorter than the other
By correcting the underlying problem, it is usually possible to reverse this type of scoliosis.
Additional causes of scoliosis can include trauma and/or infection, which then result in damage / uneven growth of the spine.

Symptoms of Scoliosis

Scoliosis can usually be seen in patients between 8-10 years of age. As the condition progresses, the symptoms may include…

Rotation of the bones in the spine, making it look as if the child’s waist or shoulders are uneven.
One or both shoulder blades may stick out.
One hip looking higher than the other
The child may lean to one side

If you notice any of the symptoms above then you should see your GP. Scoliosis can develop over a prolonged period of time and cause little on no pain initially, so it can be easily missed.

Diagnosis of Scoliosis

Scoliosis is usually initially diagnosed by a GP, who will then refer the patient on to an orthopaedic / spinal specialist. The patient will then require a physical examination of the spine, ribs, hips, and shoulders.

This clinical examination will be accompanied by some diagnostic imaging, usually included an X-ray or MRI. This will also aid in diagnosing the direction and angle of the curve. An MRI scan will also show any underlying neurological conditions (that affect the nerves and muscles), although this type of scan will usually only be performed on children experiencing back pain / a child that appear to have severe curvature.

Treatment options for Scoliosis

Treatment for scoliosis will depend on the patient and their condition. Although there are some guidelines for treatment of scoliosis, there are numerous factors that need to be considered to ensure the most effective outcome for the patient. This includes: the sex of the patient, the curve pattern, the severity of the curve, the bone maturity, and the location of the curve.

Treatment options include:

Braces

For children with moderate scoliosis and continued bone growth, the patient may be treated with a brace. This will not cure scoliosis, nor reverse the curve, but it will usually prevent continued progression of the curve.

Most children with scoliosis will wear their brace in both the day and night. It shouldn’t affect their day to day activities, and if necessary the brace can be removed to participate in sports. A child will stop wearing the brace when their bones stop growing.

There are two main types of braces:

Underarm / Low-profile: Also known as a thoracolumbosacral orthosis (TLSO), this brace is made of plastic and contoured with the body. The brace is very subtle when worn under clothing, (as it fits underneath the arms, and around the rib cage, lower back and hips). This type of brace cannot help with the treatment of curves in the upper spine.
Milwaukee: This brace covers the full torso and has a neck ring with rests for the chin and the back of the head. This type of brace is less manageable that the underarm brace, and is therefore usually used only when an underarm brace would not be suitable.

Surgery

Scoliosis will usually typically progress over time, so your consultant may discuss the option of scoliosis surgery. This is often performed when the curvature of the spine is greater than 50 degrees. This type of surgery is known as spinal fusion, which aims specifically reduce the severity of the spinal curve.

Spinal fusion surgery involves connecting two or more of the bones in your spine (vertebrae) together, using new bone. The spine is accessed by the back (posterior) or the side (anterior), and Consultant Spinal Surgeons may use metal rods, hooks, wires and/or screws to hold the spine straight and still, while the bone is healing.

Spinal fusion surgery is a major operation. If the surgery does not work then it is sometimes performed again to correct the problem.