Scoliosis

What is Scoliosis? 

  • When Scoliosis develops, the spine bends sideways and rotates along its vertical axis, creating a curvature.
  • Scoliosis is being defined when the curvature is greater than 10 degrees, and it is commonly referred as “C-shaped” or “S-shaped” backbone.
  • Not only does Scoliosis affect the appearance, more importantly it could lead to serious long-term physiological consequences if the condition is left untreated and the curvature worsens. In severe cases, Scoliosis could impact breathing, heart and lung function, and compress the nerves.
  • Scoliosis is often being discovered from age 10 to 15. Since Scoliosis is not preventable, it is crucial to diagnose Scoliosis or any abnormality of the spine as early as possible. If Scoliosis is being diagnosed early enough, the condition is actually manageable. 

Common Types of Scoliosis: 

(1) Idiopathic Scoliosis  

  • Most common type of Scoliosis, affects up to 80% of Scoliosis patients. As the name “idiopathic” suggests, there is no known cause for this type of Scoliosis.
  • There is usually no spinal abnormality observed when the child was born, however signs and symptoms of Scoliosis starts to appear during puberty, hence it is also referred as “Adolescent Idiopathic Scoliosis (AIS)”.

 

(2) Congenital Scoliosis 

  • This type of Scoliosis happens before birth, as a result of embryological malformation of the spine. The prevalence is about 0.01%.

 

(3) Neuromuscular Scoliosis 

  • This type of Scoliosis happens because of other neurological or muscular diseases, such as muscular dystrophy, cerebral palsy etc.

Who is more prone to Scoliosis? 

  • Scoliosis affects both boys and girls. In mild cases, boys and girls are equally affected. However, clinical data suggested that girls are 8 times more likely to develop severe Scoliosis. 
  • Clinical data also suggested that there is heredity factor relating to Scoliosis, but the exact genes have yet to be identified. It has been observed in recent research that about 1 in 3 children whose parents have Scoliosis, will develop Scoliosis. 

What causes Scoliosis?

  • It is common to believe poor posture, rounded back, carrying heavy things, unequal leg length etc. are causes of Scoliosis, however all of these indeed do not lead to Scoliosis. 
  • In fact, the cause of most Scoliosis cases (80 – 85%) is unknown. 

What are the signs and symptoms of Scoliosis? 

  • Early signs and symptoms of Scoliosis are not always easy to observe; however, parents can look for the below signs, and consult healthcare professionals when in doubt.
  • In addition, since there is heredity factor in Scoliosis, if any of the children’s siblings or close family members have Scoliosis, parents should pay extra attention to these symptoms and make use of the below simple back check, and ensure regular spine check-up is performed by qualified healthcare professionals. 

Common Signs and Symptoms of Scoliosis: 

  • Uneven shoulders 
  • Uneven waistlines 
  • Protruding shoulder blade (scapula) 
  • Pelvis or hip leans toward one side more 

Simple Back Check#:  

1. Take off the child’s top and have he/she stand with his/her back facing you, showing the child’s head, shoulders, waist and hip clearly. Look at the child from behind and carefully check for the below sings:

  • Any uneven shoulder levels? 
  • Any uneven or protruding shoulder blades? 
  • Any curvature of the spine observed?  

2 . Ask the child to bend forward and observe any asymmetry in the back, and check if the ribcage protrudes significantly.

  • If any of the above signs have been observed, your child might be at risk of Scoliosis and a detailed check-up shall be arranged with your physician. 

＃The above check is only meant to be used as a preliminary screening and shall not be treated as a diagnosis. You should always consult qualified healthcare professionals when in doubt. 

Treatment Options for Scoliosis:

(1) Observation 

  • In majority of Scoliosis patients with mild curvature, immediate treatment is often not required. If the patient is still in puberty and growing, regular check-up in every 4 to 6 months is recommended to monitor any progression of the curvature. 

(2) Bracing

  • Bracing is the most supported evidence-based treatment option for Scoliosis, especially in growing children and adolescents. 
  • It is crucial to begin bracing at their most active growth age in order to maximize the treatment outcomes. If the brace is well-designed and being worn diligently with enough wearing time, it is possible to avoid surgery in the future.
  • Every brace is unique and is custom-made according to the patient’s body shape, severity of the curvature, and daily activity requirement. With input from orthopedic doctor and Orthotist, each brace is specially designed and made. As the patient continues to grow, the brace should also be reviewed periodically for adjustment if necessary.
  • The followings are some common types of Scoliosis braces. Due to difference in design, you should always consult your physician and Orthotist before determining which type of Scoliosis brace to go for. 

 

Full-time Brace

  • Common type of Scoliosis brace and traditionally requires to be worn for more than 23 hours per day. It can be worn underneath clothes, and has been proven to be an effective bracing method if being worn correctly and consistently. 

Night-time Brace

  • Scoliosis brace that is designed to be worn only at night-time while sleeping. As the patient is only required to wear the brace during night-time, it minimizes the interference in their day-to-day activities. 
  • Growth of the spine happens mostly at night. Therefore Night-time Brace has been proven to be an effective Scoliosis treatment, if being designed and worn correctly, and consistently with enough wear time. 

(3) Surgery 

  • Surgery is often recommended in severe Scoliosis cases. With advanced technologies and surgical techniques, precision and safety of Scoliosis surgeries have vastly improved. 

Spinal Fusion Surgery

  • Surgeon learns about the patient’s internal organ structure and plans the surgery with the help of pre-operative CT (Computed Tomography) scan. During the surgery, computer assisted navigation allows the surgeon to work hand in hand with the system’s camera and through immediate responds of surgical instrument, orthopedic implants can be placed precisely, bypassing vital internal organs and nerves. 
  • The correction from Spinal Fusion Surgery is permanent as the orthopedic implants do not require regular replacement. 

 

Non-fusion Scoliosis Surgery  

  • Suitable for patients whose spines are still growing. The surgery is minimally invasive and performed with the help of thoracoscopy (camera that allows surgeon to view inside the chest) to connect the implants (titanium screws) via vertebral body tethering (VBT). 
  • The surgery utilizes the remaining growth potential of the patient’s spine to gradually correct the curvature. 

 

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