Scoliosis

Does your child have uneven shoulders, with one shoulder appearing higher than the other? Or an oddly curved spine that looks like the alphabet S? These are some of the symptoms of scoliosis, a medical condition commonly affecting children and adolescents, particularly girls.

Scoliosis - Prevalence

The prevalence of scoliosis is the highest during the growth spurt years, between the ages of 9 and 15. Scoliosis also affects adults, but is less common.

In scoliosis, the normally straight spine curves from side to side due to a deformity in the bone. The deformity can be congenital, present from birth, or it can develop during the growing years. Most often, there is no known cause, and the condition is then called “idiopathic scoliosis”.

“Scoliosis is a deformity of the spine, and should not be confused with poor posture, which is generally associated with weak muscles of the spine,” says Dr Guo Changming, Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital.

Types of Scoliosis

• Idiopathic scoliosis: This most commonly affects children over the age of 10 when it is referred to as adolescence scoliosis. This type of scoliosis can also affect children below the age of 3 (infantile scoliosis) and children between 3-10 years (juvenile scoliosis). In Singapore, the prevalence of idiopathic scoliosis in schoolgirls is 1.4 per cent at the age of 11-12 and 2.2 per cent at the age of 13-14.
• Congenital scoliosis: Present at birth and caused by a bone abnormality.
• Neuromuscular scoliosis: Caused by an abnormality in muscles or nerves, and commonly seen in patients with spina bifida or cerebral palsy.
• Degenerative scoliosis: Occurs later in life and may result from injury to bone or degeneration of joints found in conditions such as arthritis or osteoporosis.
  

• Abnormal curving of the spine which appears as an S or C shape
• Uneven shoulders or a prominent shoulder blade
• Uneven hips
• Uneven waist, with a tilt to one side
• In adult females, there may be uneven breasts with one breast appearing higher
  

Causes of Scoliosis

In severe cases, the rib cage may press against the lungs and heart causing complications such as:

• Breathing problems
• Lung and heart damage
• Nerve damage
• Persistent back pain

Scoliosis cannot be overcome by correcting posture. Food, vitamin supplements and exercise programmes have also not been found to be helpful in treating the condition or halting its progression. However, scoliosis patients are advised to stay fit and active for a better prognosis.

“If patients get appropriate treatment for scoliosis at an early stage, they can go on to lead normal lives,” says Dr Guo.

“Scoliosis is not caused by carrying heavy objects, such as heavy school bags, strenuous sports, poor posture, or a lack of calcium and other nutrients in the diet,” says Dr Guo. “Though the cause of idiopathic scoliosis is by definition unknown, it may have a genetic basis since it is known to run in families.”

The treatment for scoliosis depends on the age of the patient, the severity of the spine condition, and the cause.

Most patients with idiopathic scoliosis who have a curvature that is less than 25 degrees, don’t need treatment. These patients will simply need to be observed at regular intervals of 4-6 months. Observation involves a physical examination and an X-ray.

“Children whose self-esteem is affected because of scoliosis, may need counselling support in addition to the normal treatment procedures,” says Dr Guo Changming, Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital.

For significant cases of scoliosis, treatment options include:

• Braces: These body braces are prescribed for children whose bones are still growing. The child will have to wear the brace continuously for one or two years to halt the progression of the spinal curve. The brace will not reduce the curvature that is already present. In adult patients, braces are recommended for short periods, such as when they are doing manual work. Long-term use for adults can cause the spine to stiffen and the back muscles to weaken.
• Surgery: Surgery may be required if the scoliosis continues to progress despite the braces. Patients who have a spine curvature of 40-50 degrees may be recommended spinal fusion surgery. This involves a bone graft to permanently fuse the vertebrae. Metal rods, hooks and screws are used to hold the bones in place until they fuse.

One drawback of this fusion process for children is that the bones that are joined together stop growing – hence this surgical procedure is used as a last resort for children and adolescents who still have some growth years left.

“Back braces will not help patients with congenital scoliosis or those with neuromuscular scoliosis. Congenital scoliosis is also difficult to treat with surgery and may require multiple operations,” says Dr Guo.