Princess Eugenie of York regularly posts photos of her family, fiancé, and royal work she does on Instagram. But recently she strayed from her usual social media topics when she shared photos of her X-rays which, she explained, were from a surgery she underwent for scoliosis as a child.
“I also want to honour the incredible staff at The Royal National Orthopaedic Hospital who work tirelessly to save lives and make people better. They made me better,” she wrote in the caption.
In a video and story that she made for the hospital, Princess Eugenie explained that she was diagnosed with scoliosis when she was 12 and was told she had to have it surgically corrected. She underwent an eight-hour surgery, where surgeons inserted eight-inch titanium rods into each side of her spine and one-and-a-half inch screws at the top of her neck. “After three days in intensive care, I spent a week on a ward and six days in a wheelchair, but I was walking again after that,” she wrote.
Scoliosis is a disorder in which the spine has a sideways curvature.
The curve may be S-shaped or C-shaped and can affect different areas of the spine, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD).
People of any age can have scoliosis, and there are several forms. But the most common type is idiopathic (which means the cause is unknown), and it typically develops in kids between the ages of 10 and 12 or in the early teens, the NIAMSD says. In most cases the cause of scoliosis isn't identified. However, health conditions like cerebral palsy and muscular dystrophy can also cause scoliosis, the Mayo Clinic says.
Many schools screen for scoliosis by doing the Adams forward bend test, a screening method that involves having kids simply bend forward while someone looks at the symmetry of their back, Comron Saifi, M.D., an assistant professor of orthopaedic surgery at Penn Medicine, tells SELF. If the person doing the screening notices a curve or notices that one shoulder seems to be “humped,” they’ll often recommend that the parent follow up with a specialist, Dr. Saifi says.
That said, the U.S. Preventative Services Task Force (USPSTF) recently determined that there is “insufficient” evidence that screening children and teens between the ages of 10 to 18 for scoliosis is helpful. But even if your child’s school doesn’t screen for scoliosis, their pediatrician will likely notice if something is off, Dr. Saifi says.
But scoliosis isn't always diagnosed in childhood. For instance, it's possible for scoliosis to be missed in childhood and not diagnosed until adulthood, A. Nick Shamie, M.D., an orthopaedic surgeon at UCLA Medical Center’s Spine Center in Santa Monica, Calif., tells SELF. There's also a form known as degenerative scoliosis, which usually develops in adults as the result of asymmetrical aging or degeneration of your spinal discs, Neel Anand, M.D., professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, tells SELF. That can cause a tilt in your vertebrae, causing a spinal curve, he explains.
If you notice that one of your shoulders is higher than the other, you have an uneven waist, or one shoulder blade seems to stick out more than another, you should see a specialist to get evaluated, Dr. Shamie says.
There are a few steps to getting a proper diagnosis.
Your doctor will do a physical exam that may involve the use of a device called a scoliometer, which measure’s the symmetry of your torso. The doctor will also likely look for muscle weakness, numbness, and abnormal reflexes, the Mayo Clinic says.
From there, your doctor will usually order an X-ray or MRI to get a better look at your spine, Alvin Crawford, M.D., founder of the Crawford Spine Center at Cincinnati Children’s Hospital and professor emeritus at the University of Cincinnati College of Medicine, division of orthopaedic surgery, tells SELF. Based on the results, your doctor will be able to determine whether you have a sideways curve in your spine and, if so, how much of a curve you have, he explains.
Diagnostically, having a curve that’s less than 10 degrees is not considered scoliosis, Dr. Crawford says. If you have a curve that’s greater than that, your doctor will make a recommendation for treatment based on your age and how severe your curve is, he says.
Not everyone with scoliosis needs surgery.
Most children have mild curves and usually just need to be monitored, Dr. Crawford says. But some may need to use a brace. This is usually recommended for kids whose bones are still growing, the Mayo Clinic says. The brace doesn’t cure scoliosis or reverse an existing curve, but it can help prevent the curve from getting worse.
For adults with a mild curve, other measures like physical therapy, exercise, and massage are often recommended to see if they help, Dr. Anand says. But if you're still struggling after three to six months, doctors may recommend surgery.
If you have a severe curve (whether you’re a child or adult), your doctor will probably suggest surgery to reduce the severity of the curve and help keep it from getting worse, the Mayo Clinic says. The most common type is called spinal fusion, during which surgeons connect two or more of the bones in the spine together, so they can't move independently. Pieces of bone or a bone-like material are then placed between the vertebrae, the Mayo Clinic says, and metal rods, hooks, screws, or wires are usually used to hold that part of the spine straight and still while the old and new bone material fuses together. If scoliosis is moving quickly at a young age, surgeons may even install a rod that is attached at the top and bottom parts of the spinal curve that can adjust as the child gets older, the Mayo Clinic says.
Overall, though, it's important to remember that scoliosis is treatable, which is why it’s crucial to get checked out if you suspect that you or your child has it, Dr. Shamie says. And letting it go untreated can cause pain. “Proper diagnosis is paramount for getting the right treatment,” he says.