Scoliosis is an unusual curvature of the spine.
Scoliosis is a condition where the normally straight spine curves to form 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.
There are various types of scoliosis and causes for spinal curvature. The four main types of scoliosis are:
Scoliosis is not caused by carrying heavy objects (such as heavy school bags on one shoulder), sports or physical activities, poor standing or sleeping posture, or a lack of calcium in the diet.
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 percent at 11 to 12 years of age and 2.2 percent at 13 to 14 years of age; thus, the older the child, the higher the prevalence of scoliosis.
Many signs of scoliosis are noticeable and can be detected in early childhood. These include:
Scoliosis in schoolchildren is commonly detected during screening in schools by nurses who observe for asymmetry of the trunk when the child bends forward (known as Adam’s forward-bending test).
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 percent of all male and female adolescents have scoliosis, less than one percent have curves that require medical attention. Scoliosis can be mild, moderate or severe, and treatment may include one or a combination of the following:
This non-operative scoliosis treatment 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-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 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 is recommended for growing children with curves 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:
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 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, 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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This article was last reviewed on
Wednesday, November 22, 2023
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