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University Orthopaedics, Hand

and Reconstructive Microsurgery Cluster

Scoliosis

 

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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 than 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:

  • 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 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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Doctors Pioneer New Surgery for Scoliosis

 

The National University Hospital's University Spine Centre is undertaking a pilot surgical trial that could improve treatment for those with idopathic scoliosis. The new method, which involves the insertion of a surgical device, is not only less invasive, but also allows the spine to grow, and accords it greater flexibility. 

 


(Graphic: The Straits Times)


A NEW type of surgery developed here promises to straighten the curved spines of scoliosis patient without compromising the backbone's capacity for growth and flexibility.

 

Click here to read more on Home, The Straits Times.

Click here to read article on Lianhe Zaobao.

 

 

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Pilot Surgical Trial To Correct Scoliosis Without Compromising Spinal Growth And Flexibility

 

The juvenile and adolescent years see the period of time where we see our bone growth the fastest, accounting for the rapid height gain experienced. For scoliosis patients, it also means a period of worry as it is the time when their spinal curvature tends to worsen at the fastest face. What many not realise though is that the same period could offer the best opportunity for correction of spinal curve by modulating or guiding spinal growth.

 

The National University Hospital has embarked on a pilot trial with a new surgical device that could change the way patients with idiopathic scoliosis is treated in the future.

 

Traditionally, large and progressive scoliosis curves are corrected surgically by spinal fusion and 'instrumentation', meaning the spine is straightened by metallic implants and the spinal bones in the curvature are joined together placing bone grafts between the vertebrae. The process successfully straightens the spine and prevents further progression of the curve. However, the spinal segment that is fused does not growth in length and cannot bend. Until now, there is no way to achieve spinal straightening and prevention of curve progression without limiting bone growth and spinal movement at the surgically treated spinal segment.

 

With this world's first surgical device trial that the University Spine Centre is conducting, a new device called the Scoli-Tether (MISCOLI) System, can potentially overcome the limitations of conventional spinal fusion by guiding the curved spine to grow straight, thereby permitting growth in spinal length and maintaining spinal movement in the affected segment. Allowing the patient to lead their post-surgery life as normally as any other child.

 

The Scoli-Tether is a minimally invasive thoracoscopically implanted convex growth tether that utilises remaining growth in the spine to correct scoliosis. Implanted on the convex side of the scoliotic curve, the flexible but inelastic tether limits growth on the convex side of the curve while allowing the concave side to grow. Over time, the concave side growth will correct the spinal curvature, and at the same time allow increase in spinal length and mobility within the spinal segments in the tether. For the tether to work, the child must be young and skeletally immature with sufficient remaining growth left to achieve straightening of the spine. If successful, this device could change the way young growing patients with idiopathic scoliosis are treated in the future.

 

Prof Wong Hee Kit, Head of the University Spine Centre and Principal Investigator of the surgical trial says, "This is indeed a novel surgery that can potentially benefit our patients greatly. Many patients and parents are concerned with reduced spinal growth and lack of mobility in the spine after successful spinal fusion. If successful, this device may allow us to have the best of both worlds: "a straight spine that can still grow and move".

 

 

 

The recruitment for volunteers is currently closed. 

 

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Seeking Volunteers For Scoliosis Genetic Studies

Scoliosis, a common cause of the abnormal curvature of the spine, affects about 2.5% Singapore school children and teenagers. Recent studies have suggested that genetic associations may be able to help doctors predict spinal curve progression.

 

Media Articles

Monday, 6 June 2011

New surgery promises new hope to correct scoliosis in young patients (Lianhe Zaobao)

In future, young scoliosis patients may be able to look forward to a new surgical device that will allow their curved spine to be corrected without compromising growth and flexibility.

 

Read more

 

Monday, 6 June 2011

Doctors pioneer new surgery for scoliosis (Home, The Straits Times)

A NEW type of surgery developed here promises to straighten the curved spines of scoliosis patients without compromising the backbone's capacity for growth and flexibility.

 

Read more

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Monday, 5 Mar 2012

NUH gene study for early treatment of scoliosis (The Straits Times)

Predict spinal curve progression by looking at patients' genetic profiles.

 

Read more

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