It’s Scoliosis Awareness Month!

We caught up with Candice Sutcliffe, one of our excellent Extended Scope Physiotherapists and a key part of our Spinal Service team, who offered her valuable insight in preparation for Scoliosis Awareness Month 2023. Candice has worked at Sheffield Children’s for over twenty years but has been in her current role since 2016, so is highly experienced when it comes to helping our children and young people with scoliosis.

As part of her role, Candice spends her time working in clinics, taking up a similar role to that of a consultant. She is also involved in pre-operative care, where she undertakes assessments with our patients, evaluating their posture and flexibility and gaining a better understanding of treatment expectations.

More recently, Candice became a certified Schroth Therapist. This training makes Candice, alongside a handful of other NHS physiotherapists nationally, able to deliver scoliosis-specific exercises with the aim of supplementing patients who are currently undergoing bracing treatment. Candice said: “I can give specific exercises for each specific curve type. Children and young people have responded really well to scoliosis-specific exercises, it can help with postural awareness and back pain.”

Candice did emphasize that such exercises are typically more effective in patients with less-developed curves. When caught early, scoliosis can often be managed through bracing and other methods of conservative treatment. However, a lack of recognition amongst the general public means that the team can often see curves that are too developed for bracing treatment and may require surgery. “When I talk to people about my job, they don’t know what scoliosis is. A lot of the time when we see patients and families coming through, they don’t know much about it either.”

The need for surgery can sometimes be avoided through early detection, and Candice went on to discuss the importance of public awareness, and the simple test that can be done to test for scoliosis. “As part of early detection measures, it is important to use the forward bend test. Getting that out there so that parents know about it can easily do that. It’s a very valuable tool to use.”

The forward bend test is just as simple as it sounds. It involves the patient standing up and reaching down towards their toes. This movements highlights the curvature of the spine in a manner that makes an asymmetrical curve more obvious to spot by looking for the ribs appearing more prominent on one side compared to the other. If you suspect that your child could have scoliosis, you should take them to your GP, who can assess the situation further.

Once scoliosis is diagnosed and treated, Candice was keen to highlight that there is no reason that idiopathic scoliosis should get in the way of a young person living a healthy, active life. “Scoliosis doesn’t mean that you have to stop doing sport. In many cases of adolescent idiopathic scoliosis, you can still get on with life and sport even after scoliosis surgery.”

We would like to extend a massive Sheffield Children’s thank you to our colleagues in the Spinal Service team for sharing their experiences as part of Scoliosis Awareness Month 2023.

Matt Bellamy is a current intercalating research student here at Sheffield Children’s. As part of his undergraduate course at the University of Sheffield, he has spent the past ten months researching scoliosis treatment. More specifically, Matt has been investigating the process by which 3D reconstructions can be generated by biplanar EOS images as a means of improving our understanding of how we currently treat scoliosis. Our EOS Scanner was funded by The Children’s Hospital Charity in 2019 and was just the second of its kind in the UK.

It is Matt’s hope that our state-of-the-art biplanar x-ray technology can provide a comparable 3D image to that of other imaging techniques such as CT or MRI scans, with the intention that this technology can be used to revolutionise patient interactions with minimal radiation exposure.

“With a traditional x-ray, we see the spine in a two-dimensional view. Looking at it in 3D means we can plan treatments better, and we have a better chance of knowing which patients are going to do well with certain types of surgery. Hopefully, it can also make it easier for patients to understand what the treatment is trying to do and visualise what the treatments will do to the spine. Ultimately, we are working towards 3D printing these models so that the patient can actually see their scoliotic spines”.

Matt shared his gratitude to all of his colleagues at Sheffield Children’s, who have supported him throughout his experience: “It has been an amazing experience! It has been really fun and hands on, meeting patients, surgeons, physios, orthotists, nurses. I would recommend anyone looking to go into research in scoliosis, this is one of the best places to do it.”

Matt wants to use Scoliosis Awareness Month to raise awareness of the opportunities for further research that aims to push the boundaries of scoliosis treatment across the country: “From my point of view, there’s a lot to be said for increasing awareness of how much research there still is to do. We have the opportunity to drive advancements, and it’s happening now!”

We popped down to the Spinal Nursing Department to chat with Spinal Nurses, Ellie Reid and Sarah Wright and Scanning Technician and Spinal Healthcare Assistant, Sarah Ashton. This group, alongside Lead Spinal Nurse Caron Edwards and Spinal Nurse Alice Hambling, are involved in the treatment of our children and young people with scoliosis.

When asked about the role of a spinal nurse, Ellie replied: “It’s a bit of a mix of everything really! We’re involved in pre-operative and post-operative care for patients having an operation, we organise and facilitate all the pre-op assessments several times a week, we are on hand for all clinics with consultants, we run a nurse-led clinic, we sit in and help with consultant clinic and much more!”

The team is also operating at the forefront of technological advancement, making sure that Sheffield Children delivers excellent healthcare throughout the community. For instance, as part of her role, Sarah has seen the benefits of formetric scanning first-hand. She explained:

“Formetric scanning creates an image of the outside of the child, looking at contours of back and body shape. They have to stand really still, and it projects lines on their back. The machine then takes 12 pictures in six seconds and creates a 3D image. There is no radiation involved, as it’s just a camera, so no risk at all is involved.”

This is just one of many ways that Sheffield Children’s is able to support those with scoliosis, but the team were quick to highlight that the importance of early detection in being able to provide support.

“Scoliosis Awareness month is about raising awareness so that people can feel comfortable to seek medical attention if they need it. We get a lot of patients who don’t come to us until the curves are much bigger, and there are less options. It is about noticing it early, at which point we can keep curves under the surgical threshold.”

Nonetheless, they were also enthusiastic to emphasise that a scoliosis diagnosis does not prevent patients from doing things that they would have done ordinarily.

“It is all in the degree of the curve,” said Sarah “One of our colleagues will always say to patients, ‘your back is as strong as mine, it’s just curved not straight!’ We’ve had rock climbers, footballers, swimmers, horse-riders, who have all had surgery and have gone back to competing.”

Rav Jayasuriya wears many hats. First and foremost, he is a one of our fantastic Paediatric Spinal Deformity Fellows here at Sheffield Children’s. However, alongside this role, Rav is also undertaking a PHD, researching psychology and behavioural change theory in bracing. When asked about his many roles, Rav said “It’s a challenge juggling everything alongside a busy clinical job, but so far, it’s going well! It’s showing some interesting findings about scoliosis.”

Rav is also one of the core team members running our BASIS study. Under the supervision of Chief Investigator Ashley Cole, the BASIS study is being spearheaded by our incredible teams at Sheffield Children’s who are investigating the benefits of a new form of bracing. When asked about the goal of the trial, Rav said:

“Standard spinal braces are normally worn for 20 hours a day for anywhere between one-and-a-half and four-and-a-half years. These braces are a main form of conservative treatment, but even though it’s the standard a lot of people struggle to wear it for that long.

“A night-time brace is a newer type of brace which is only worn at night-time. It is differently designed and aims to correct the spine a lot more but only needs to be worn for a shorter amount of time. Night-time braces give the freedom of not needing to wear it during the daytime.”

“The trial is trying to show that night-time bracing can be as effective as traditional bracing. We’re addressing an important problem and answering that problem in the most rigorous and scientific way possible which is really cool.”

The importance of this trial is also heightened by the need to enhance public knowledge of scoliosis in all its forms and educate our community on the importance of early detection. As Rav highlighted:

“The earlier we can identify that someone has a curve developing, the wider our opportunity of treatment is. If we meet someone with a small curve with growth potential remaining, we can try and avoid surgery. Sometimes, when we meet someone who has a larger curve, our only option remaining is surgery.”

As part of Scoliosis Awareness Month, we had a chat with Edward Bayley, one of our fantastic Consultant Spinal Surgeons here at Sheffield Children’s. Ed often operates on patients with all types of scoliosis as part of his role, with his particular area of specialisation being in the treatment of neuromuscular scoliosis.

Throughout the year, Mr Bayley is involved in a number of clinics alongside our team of neurology and respiratory consultants and physiotherapists, with his Thursdays often consisting of a full day in theatres operating on our patients. Whilst he is primarily involved within the surgical process, Mr Bayley emphasised the growing importance of conservative treatment methods prior to surgery in the effective treatment of scoliosis. He said: “There is a growing body of evidence that early treatment on the spinal curve, such as brace treatments, works. We want people to know about these”

Sheffield Children’s is one of just 24 specialist paediatric spinal centres across the country, and Mr Bayley was keen to highlight that our patients would be receiving excellent healthcare during their time with us.

“We want to reassure people that, whilst these are conditions that can have an effect on their lives, we’re able to look after them. For us, it is something that we look after a lot. The important thing is to come forward for treatment and not to be too scared of [doing so]”

Mr Bayley also spoke briefly on the misinformation around the causes of scoliosis, and the importance of public awareness in the effective treatment of the condition:

“I think there are two key myths. The first is that crossing your legs causes scoliosis and the other is that going on the trampoline causes it. Activities do not cause scoliosis; we actually think that there’s a genetic element.”

In fact, in many cases, patients were able to continue participating in routine activities after receiving their diagnosis and treatment. As Mr Bayley said: “You often don’t have to stop doing activities, there isn’t anything that we say that you’re not allowed to do after proper recovery.”

We have a fabulous team here at Sheffield Children’s who work together to provide outstanding treatment and care for our children and young people. In the build up to Scoliosis Awareness Month 2023, we caught up with two of our Clinical Specialist Orthotists, Steve Hewitt and Andrew Mills.

As part of their roles, Andrew and Steve are both highly specialised in bracing, a conservative treatment of scoliosis. Conservative treatments, such as bracing and physical therapy, are often delivered before the scoliotic curve reaches the surgical threshold. During his time at Sheffield Children’s, Andrew has overseen the development of bracing through the years and is optimistic about the future of bracing treatments at Sheffield Children’s.

“When I started here, Milwaukee Bracing was the standard. It took a number of years before the Boston Brace was introduced, marking a move to moulded plastic underarm bracing. However, this is now 50-year-old technology. Bracing, however, has developed significantly over the last 50 years, and there are now far more efficient bracing techniques.”

Our team is working at the cutting-edge to make sure that we are able to deliver excellent healthcare. For example, hyper-corrective bracing is a newer alternative to standard Boston bracing that is created through the use of CAD software and aims to correct scoliotic spinal curves. As Steve highlighted:

“We’re the only NHS spinal centre that offers hyper-corrective postural bracing as a standard for everyone. All the early evidence suggests that these braces are significantly more effective than standard corrective bracing.”

As with many of our colleagues working within the treatment of scoliosis, Andrew and Steve highlighted the importance of early detection:

“There’s a window of opportunity to conservatively treat Scoliosis. A brace for your spine isn’t quite the same as a brace for your teeth, in that you can do it at any time. You can modulate growth whilst a child is growing. The earlier you identify the curve, the more time you have to make a difference.”

Currently, 88% of our children and young people with adolescent idiopathic scoliosis are already beyond the current threshold for bracing when we first meet them. Greater public awareness of scoliosis would make it more likely that a higher proportion of future patients will be eligible to receive bracing treatment from members of our team, thereby avoiding the need for surgery.

Did you know that Usain Bolt, the world’s fastest man, actually has scoliosis? This is something that Lee Breakwell, Clinical lead for our Spinal team, often tells his patients with Adolescent Idiopathic Scoliosis (AIS) to reassure them that it is often safe to participate in sport despite their condition. Lee has over 25 years of experience in paediatric orthopaedics, and has undertaken a wide range of surgical procedures, most commonly dealing with scoliosis.

As part of Scoliosis Awareness Month, Lee believes that it is important to make people aware of what scoliosis is, and how it can be spotted through the forward bend test. Lee said: “Scoliosis is more common that most people think. If you ask someone on the street whether they have heard of it, then the answer would be no. There’s usually one person in every class that has a small curve that isn’t necessarily noticed”

Lee was also quick to point out that increasing public awareness of scoliosis could lead to an increased likelihood of early identification: “You can brace a child with a curve between 20 and 40 degrees, which often reduces the need for surgery. However, the standard size curve that we see is 40 degrees, so it is too late for bracing. Being aware is helpful for those individuals who could avoid surgery if the curve were spotted earlier.”

However, even after surgery, Lee highlighted that our children and young people will often still be able to live a healthy and active life after proper rest and recovery. He said: “When they have surgery, we ask them to be careful for a period of time, and then their back is actually stronger on account of the metal rods. A lot of our kids return to their everyday sports and activities”

Whilst many of the patients that we meet have Adolescent Idiopathic Scoliosis (AIS), Lee was keen to emphasise that this was not the only form of scoliosis that we at Sheffield Children’s specialise in: “Scoliosis is a basic diagnosis. Whilst many of the cases that we see are Adult Idiopathic Scoliosis, we are also a specialist unit for congenital scoliosis. We have a process of monitoring from birth and, if they need an operation, we’re in a position to make that decision.”

“In addition, we also see patients with syndromic scoliosis. This is a side-effect of other health conditions, so we often see referrals from colleagues within the Trust. For instance, we frequently collaborate with our world-class metabolic bone disease service to determine whether it is necessary to operate on patients with syndromic scoliosis which has developed as a consequence of osteogenesis imperfecta.”