Scoliosis - by Dr Saw Lim Beng
05 April 2019
Spinal deformity- Scoliosis
By Dr Saw Lim Beng, Consultant Spine Surgeon
Scoliosis is a condition where the spine or back bone becomes bent to the side taking the shaped of S or C, and therefore more commonly known as the S-shaped or C-shaped spine. The condition usually occurs among teenagers. Most parents are not aware of this condition, and when they do notice it in their children, it tends to be always in the late stage with very pronounced deformity.
Scoliosis usually develops during the adolescent stage. It starts just before the child shoots up in the height, then it progresses very rapidly during the rapid growth period and then slows down or stops once the child reaches bone maturity. Both boys and the girls can be affected but girls tend to have more severe curvature. Scoliosis also can occur among young toddlers and infants.
The deformity develops very gradually. In the early stage, the child may have slight imbalance of the shoulder level, common with the right shoulder higher than the left. At this stage, one can notice slight bulging on the back of the right chest (also can happen on the left but rare).
As the disease progresses, the hump/ bulge on the back becomes bigger. The body starts to tilt to one side. In some patient with a curve on the lower spine, the pelvis may be tilted especially when walking and usually this gives a false impression that the child has one leg shorter than the other.
Scoliosis is commonly linked to a disease that occurs from birth, but this congenital type only occurs in a minority group. The patient usually has the spine curvature from an infant stage. The other cause of scoliosis is disease or defect in the nerve or muscle, which is known as neuromuscular scoliosis. When the cause cannot be found, the scoliosis is termed idiopathic scoliosis. Usually this disease is called “Developmental” and the child is normal from birth till toddler, and disease starts when the child enters puberty age. Idiopathic scoliosis forms the majority group, which contributes to around 80 percent of all scoliosis diagnosed.
Scoliosis can be easily diagnosed by asking the child to bend forward to detect any occurrence of hump on the back (Figure). Alternatively, a simple spine X-ray can easily detect a mild deformity and it also allows the doctor to measure the severity of the deformity. Once the scoliosis is detected, the doctor needs to carry out a detailed assessment to find out the cause (congenital, neuromuscular or idiopathic). In the congenital group, further investigations are needed as the patient might have associated heart or kidney problem. The doctor will also need to evaluate the maturity of the child to determine the likelihood of the curve to become more severe or if it has been stabilised.
The treatment of scoliosis is dependent on two main factors; severity of the curve and the maturity of the patient. For small curve of lesser than 30 degrees, the doctor usually practises a ‘wait and see’ approach. If the curvature does not progress, the doctor will continue to observe the patient till he/ she reach maturity. Many conservative measures like physiotherapy/ exercise can be practised during the ‘wait and see’ period.
A young immature child with high potential to grow will require more aggressive treatment such as bracing or even surgery when the curvature extends beyond 30 degrees. Whereas a child that has completed the bone growth is likely to be stable and nothing needs to be done unless the curvature is larger than 45 degrees when measured on the X ray.