Not all sideways curvatures of the spine need major surgery. Here’s how this condition is treated amongst kids.

Scoliosis occurs when a normally straight spine curves laterally (side-to-side), forming an “S” shape.

When viewed on an X-ray, the spine of a person with this condition appears like an “S” or a “C” shape rather than a straight line.

“Scoliosis can be detected at all ages, depending on the type of scoliosis,” notes Associate Professor Gabriel Liu, Head & Senior Consultant, University Spine Centre, National University Hospital (NUH).

Although scoliosis affects children of all races, it’s more common in girls than boys. For every seven girls who have scoliosis, only one boy is diagnosed with this condition. According to Prof Liu, The University Spine Centre in NUH sees about 4,500 to 5,000 cases of scoliosis a year, predominantly amongst youngsters aged 10 to 18.

SmartParents speaks to Prof Liu about scoliosis in children, which is often only diagnosed during a routine health check in school.

Dr Liu, what causes scoliosis?

There are many causes of scoliosis. Congenital scoliosis is due to congenital birth defects in the spine and is often associated with other organ defects. Neuromuscular scoliosis is due to the 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. Syndromic scoliosis is caused by conditions such as Down syndrome and neurofibromatosis. The most common form of scoliosis ― seen in 90 per cent of the cases ― is adolescent idiopathic scoliosis (AIS), which occurs in kids as young as 9 years old. There is no established cause found, but research points towards genetic causes.

How is scoliosis diagnosed?

Scoliosis in school children is commonly detected during screening in schools. The Adam’s forward bending test is used to observe for asymmetry of the trunk when the child bends forward.

The most common form of scoliosis ― seen in 90 per cent of the cases ― is adolescent idiopathic scoliosis (AIS), which occurs in kids as young as 9 years old.

If we suspect that the child has scoliosis, we will request a long spine standing scoliosis X-ray. The ultra-low dose imaging system enables the whole body, frontal and lateral images to be taken simultaneously. This reduces the need for multiple X-rays to be taken, which reduces the overall radiation dose that the child is exposed to.

We do an MRI and CT scan only if the curve is abnormal or the cause of scoliosis is unusual. Should the patient require surgery, we will also conduct the bending X-rays test curve flexibility for surgical planning.

How is each type of scoliosis identified?

We look for the following signs and symptoms for congenital and idiopathic scoliosis:
* An “S” shaped curve in the back when standing.
* Curvature of the body to one side when viewed from the front or back.
* One shoulder appears higher than the other.
* A tilt in the waistline.

In neuromuscular scoliosis, the curve is usually large and patients are often wheelchair- bound due to their neurological conditions. In such cases, we recommend surgery to allow the child to be able to sit on a wheelchair properly.


What treatment options are there in Singapore?

The primary objective for spinal deformity treatment is to stop the progression of scoliosis and maintain a balanced spinal alignment. Uncontrolled scoliosis progression may result in a large deformity and lead to restriction in the lungs and heart function.

We start with observation, 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 or a progressive curve will require treatment in the form of a brace. 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.

Surgery is recommended when the curves are large or greater than 45 degrees to prevent further progression. It’s also the best option to control the curve when brace treatment is unsuccessful.

If the scoliosis is confined to the chest region, a thoracoscopic “keyhole” technique that requires only four to five small openings on the side of the chest can be done.

The most common surgical treatment for scoliosis is spinal fusion using special titanium screws, hooks, rods and bone graft. We carefully straighten the curve through incisions made along the back of the spine.

If the scoliosis is confined to the chest region, a thoracoscopic “keyhole” technique requiring only four to five small openings on the side of the chest can be done.

Using modern spinal instrumentation, scoliosis patients who have undergone surgery can lead normal and independent lives and can also participate in most, if not all forms of sports. However, in the first few months after surgery, they’ll need to be careful with physical activities.

What is the biggest misconception people have about this condition?

That scoliosis is caused by carrying heavy objects, such as heavy school bags on one shoulder, because of sports or physical activities, poor standing or sleeping postures, or a lack of calcium in the diet. It’s also 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.

What is the long-term outlook for a child with scoliosis?

Patients with a small curve, less than 30 degree at spinal maturity or adulthood, should live a normal life ― the prevalence of back pain is similar to the normal population.

Photos: iStock

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