Scoliosis

2024/05/31

What is Scoliosis?

Scoliosis is a condition characterised by the lateral (side-to-side) curvature of the normally straight spine, forming an "S" or "C" shape, as observed in X-rays.

These changes occur due to the wear and tear of the discs, which act as shock absorbers between the vertebral bodies of the spine, as we age. As the intervertebral discs undergo wear and tear, they can start to collapse or prolapse, resulting in reduced flexibility.

What are the Types and Causes Of Scoliosis?

There are various types of scoliosis and causes for spinal curvature, including:

Idiopathic Scoliosis is one of the most common forms of scoliosis. Although it is known to run in families, its cause is unknown, and no responsible genes have been identified. Idiopathic scoliosis is present in three age groups: infantile (younger than 3 years old), juvenile (3 - 10 years old), and adolescent (above 10 years old). Adolescents are most prone to the disease. Children with idiopathic scoliosis appear healthy without bone or joint disease earlier in their lives.
Congenital Scoliosis occur at birth with spine defects and is often associated with other organ defects.
Neuromuscular Scoliosis occurs when losing control of the nerves or muscles that support the spine. Cerebral palsy and muscular dystrophy are common causes.
Degenerative Scoliosis may be caused by degeneration of the discs (which separate the vertebrae) or arthritis in the joints that link them. This type of scoliosis occurs later in life, unlike the first three types present in childhood.

Scoliosis is not caused by carrying heavy objects (such as heavy school bags on one shoulder), sports or other physical activities, poor standing or sleeping postures, or dietary calcium deficiency.

How Common Is Scoliosis?

Scoliosis affects children of all races but is more common in girls than in boys (ratio of 7:1).

In Singapore, the prevalence of adolescent idiopathic scoliosis in schoolgirls is 1.4% at 11–12 years of age and 2.2% at 13–14 years of age.

Thus, higher age groups correlate with higher prevalence of scoliosis.

Symptoms

Many signs of scoliosis are noticeable and can be detected in early childhood. These include:

“S” shaped curve in the back when standing
Curving of the body to one side when viewed from the front or back
One shoulder that appears higher than the other
A tilt in the waistline
In females, one breast may appear higher than the other

Scoliosis in school children is commonly detected during screening in schools by nurses who observe for asymmetry of the trunk when the child bends forward (Adam’s forward bending test).

Treatment

Scoliosis cannot be corrected by learning to sit or stand up straight. Food or vitamin supplements and exercise programmes have also shown no significant value in treating the condition. Although about 10% of all male and female adolescents suffer from scoliosis, less than 1% have curves that require medical attention. Scoliosis can be mild, moderate or severe. Treatment may include one or a combination of the following:

Observation

This non-surgical treatment of scoliosis involves observing the deformity with regular examinations and follow-up x-rays. Curves that are less than 25 degrees can be observed at four to six-month intervals. A growing child who has a curve greater than 25 degrees will require treatment. A brace may be used to treat progressive curves or curves more than 25 degrees.

Bracing

Bracing is designed to stop the progression of the spinal curve but does not reduce the amount of angulation already present. Thoraco-lumbar-sacral orthosis (TLSO) is one of the more commonly used scoliosis braces. Spinal bracing is recommended for growing children with progressive curves. Surgery is recommended when the curves are large.

Surgery

Surgery is recommended for curves greater than 40 degrees in children and for curves greater than 50 degrees at any age. It is a common misconception that scoliosis does not progress after skeletal maturity. It has now been shown that if left untreated, large idiopathic curves above 50 degrees will continue progressing in adulthood.

Surgical treatment of scoliosis may be indicated for any of these reasons:

To prevent further progression of the curve
To control the curve when brace treatment is unsuccessful
To improve an undesired cosmetic appearance
For reasons of discomfort or postural fatigue

The most common surgical treatment for scoliosis is spinal fusion using special stainless steel/titanium rods, hooks, screws and bone graft to carefully straighten the curved portion of the spine. In suitable patients, the surgery can be achieved through thoracoscopic "keyhole" techniques that require only four to five small openings on the side of the chest. Using modern spinal instrumentation, scoliosis patients who have undergone surgery lead normal and independent lives and can participate in most or all forms of sports. However, during the initial few months post-surgery, patients are advised to gradually ease into physical activities.

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