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Definition
Scoliosis is a condition where the normally straight spine curves laterally (side-to-side), forming an “S” shape. When viewed on an x-ray, the spine of a person with scoliosis appears like an “S” or a “C” shape rather than a straight line.
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Types And Causes Of Scoliosis?
There are various types of scoliosis and causes for spinal curvature. The four main types of scoliosis are:
• Idiopathic scoliosis is one of the commonest forms of scoliosis. As its name suggests, the cause is unknown. It has been known to run in families but no responsible genes have been identified presently. idiopathic scoliosis can present at three age groups: infantile (younger than 3 years old), juvenile (3 - 10 years old), and adolescence (older than 10 years old). The commonest age group is the adolescent age group. Children with idiopathic scoliosis appear to be totally healthy without any bone or joint disease in the early part of their lives.
• Congenital scoliosis is due to congenital birth defects in the spine and is often associated with other organ defects.
• Neuromuscular scoliosis is due to loss of control of the nerves or muscles that support the spine. Common causes of this type of scoliosis are cerebral palsy and muscular dystrophy.
• Degenerative scoliosis may be caused by degeneration of the discs (which separate the vertebrae) or arthritis in the joints that link them. Unlike the first three types that present in childhood, this type of scoliosis occurs later in life.
Scoliosis is not caused by carrying heavy objects (such as heavy school bags on one shoulder), sports or physical activities, poor standing or sleeping postures, or a lack of calcium in the diet.
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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, the older the child, the higher the prevalence of scoliosis.
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Signs Of Scoliosis
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).
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Treatment
Scoliosis cannot be corrected by learning to sit or stand up straight. Food or vitamin supplements and exercise programmes have not been shown to be of value in treating the condition. Although about 10% of all male and female adolescents suffer from scoliosis, less that 1% have curves that require medical attention. Scoliosis can be mild, moderate or severe and treatment may include one or a combination of the following:
Observation
This non-operative 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 4 to 6 monthly 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 it 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. When the curves are large, surgery is the recommended option.
Surgery
Surgery is recommended for growing children with curves that are greater than 40 degrees and for curves that are more 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 to progress in adulthood.
Surgical treatment of scoliosis may be indicated for any of these reasons:
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To prevent further progression of the curve
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To control the curve when brace treatment is unsuccessful
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To improve an undesired cosmetic appearance
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For reasons of discomfort or postural fatigue
The most common surgical treatment for scoliosis is a 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 4 to 5 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, if not all forms of sports. However, in the first few months after surgery, they need to be careful with physical activities.
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