What is scoliosis?

Our spine comprises soft tissues like muscles, ligaments, nerves, and 33 vertebrae stacked on top of each other. The spine appears straight when viewed from behind; however, it has a natural s-shaped curve that occurs through the different portions of the spine – the cervical, thoracic, and lumbar regions. 

Scoliosis occurs when there is an abnormal sideways curve of the spine. This sideways curve gives the spine an s-shaped or c-shaped curvature, and it can happen anywhere on the spine, thus giving rise to different types of scoliosis. These include:

  • Thoracic scoliosis: characterised by a c-shaped curvature in the middle of the spine.
  • Lumbar scoliosis: characterised by an abnormal curve at the bottom of the spine.
  • Thoracolumbar scoliosis: characterised by abnormal curvature at the junction of the middle (thoracic) and lower (lumbar) back.
  • Combined scoliosis: characterised by an abnormal curvature at both the middle and bottom of the spine.
scoliosis types
The type of scoliosis depends on the location of the curvature.

What are the causes of scoliosis?

A variety of factors causes scoliosis; these are:

  • Idiopathic scoliosis: the most common form of scoliosis, and its cause is unknown. It typically affects children and can be categorised into three groups: children below the age of 3 (infantile scoliosis), children between 3 and 10 years old (juvenile scoliosis), and children over the age of 10 (adolescent scoliosis).
  • Congenital scoliosis: congenital scoliosis means that an individual is born with scoliosis when the vertebrae of the spine do not form properly before birth.
  • Neuromuscular scoliosis: the second most common type of scoliosis, neuromuscular scoliosis is caused by problems in the nerves or muscles that support the spine; conditions like cerebral palsy and muscular dystrophy are known to lead to this.
  • Degenerative scoliosis: also known as adult-onset scoliosis, degenerative scoliosis is caused by disc degeneration or arthritis in the spine joints and tends to manifest later in life. 
Scoliosis symptoms include a tilted and uneven waistline, one hip higher than the other, and a head misaligned from the pelvis.

What are the symptoms of scoliosis? 

Scoliosis signs are often visible, even in childhood. Scoliosis symptoms include:

  • Abnormal curve in the spine resembling an "S" or "C"
  • Body curving or leaning to one side when seen from the front or back
  • Uneven shoulders
  • Tilted waistline
  • Uneven breasts, with one appearing higher (in females)
  • Head is not aligned with the pelvis
  • One hip is higher than the other

If you or your child is experiencing any of the symptoms stated above, make an appointment with Chou Neuroscience Clinic today.

Is scoliosis painful?

Depending on the severity, scoliosis may cause pain in some individuals. The abnormal curvature of the spine causes the ribcage to tilt and deviate from its normal position. This can cause strain to the back muscles, resulting in pain.

Who is at risk of scoliosis in Singapore?

Several factors increase the risk of an individual developing scoliosis; these factors are:

  • Gender: scoliosis is more common in females than males. 
  • Age: scoliosis symptoms tend to appear during puberty, between the ages of 10 to 18.
  • Genetics: a family history of scoliosis increases the risk of an individual developing the condition.
  • Medical conditions: medical conditions such as spina bifida, cerebral palsy, muscular dystrophy, and spinal muscular atrophy increase the risk of developing scoliosis.
  • Injury: spine injuries increase the risk of developing scoliosis.

How is scoliosis diagnosed?

Scoliosis is diagnosed in the following ways:

  • Physical examination: the first step of diagnosis is a physical examination and measurement of the degree of scoliosis. This is conducted using the Adam’s forward bend test, where the individual bends forward from the waist with their arms relaxed at their side. 
  • Neurological examination: a neurological exam will check for muscle or nerve weakness and the body’s reflexes.
  • Imaging tests: imaging tests such as x-rays, magnetic resonance imaging (MRI), or an ultrasound will be performed to identify the severity of the spine curvature. The Cobb angle measurement is taken from the X-ray image of the spine to determine the severity of scoliosis.
adam’s forward bend test
Scoliosis is diagnosed using various tests, including the Adam’s forward bend test.

What are some treatment options for scoliosis? 

In Singapore, treatment options for scoliosis include: 

  • Observation: if the curve is less than 25 degrees, it is regularly monitored with check-ups and X-rays. Curves over 25 degrees in growing children may require treatment, often involving a brace.
  • Bracing: used to prevent the curve from getting worse, especially in growing children with progressive curves. They do not reduce the existing curve. Surgery becomes an option if the angles are large.
  • Surgery: recommended for children with curves over 40 to 50 degrees, regardless of age. It is a misconception that scoliosis stops progressing after skeletal maturity. 

Modern surgery typically involves spinal fusion using special materials to straighten the spine. In suitable cases, minimally invasive techniques are used. After surgery, patients can lead everyday lives but should be cautious with physical activities initially.

Counselling support may be offered to patients experiencing self-esteem issues due to scoliosis.

Frequently asked questions  

How prevalent is scoliosis? 

Scoliosis affects children, with a higher incidence among girls compared to boys (7:1). In Singapore, the occurrence of adolescent idiopathic scoliosis in schoolgirls stands at 1.4% between ages 11 and 12 and increases to 2.2% for ages 13 to 14. As a child grows older, the likelihood of scoliosis also increases.

Can I live normally with scoliosis?

Individuals with scoliosis typically lead normal lives and can participate in various activities, including sports and exercise. The condition often does not lead to significant discomfort or other health problems and tends to stabilise after a person's growth period. If it worsens, consult a doctor.

What happens if scoliosis is left untreated?

If left untreated, moderate to severe scoliosis can result in discomfort, further spinal deformity, and potential complications affecting the heart and lungs.

How can I prepare for scoliosis surgery?

--- Make lifestyle changes: quit smoking and exercise to your comfort level to recover quicker.
--- Talk to the experts: your neurosurgeon can guide you through the preparation process, which includes obtaining medical clearance from your primary care doctor.
--- Complete the necessary tests: your neurosurgeon will order various tests based on your medical condition, including: 
----- X-rays from different angles
----- Magnetic resonance imaging (MRI) for visualising the lumbar discs
----- Myelogram and computed tomography scans (CT scans) to assess nerves, spinal cord, and bones
----- Kidney ultrasound to check kidney function
----- Echocardiogram in specific cases to examine the heart

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Copyright © 2023 Chou Neuroscience Clinic. All Rights Reserved