Scoliosis (Curved Spine)

Scoliosis is not a condition caused by carrying heavy objects (eg. a heavy school bag on one shoulder), sports or physical activities, poor standing or sleeping postures or a lack of calcium in your diet.

Idiopathic scoliosis is from an unknown cause and can also be a result of a genetic pre-disposition. It typically starts in the young. This type of scoliosis tends to be more common in girls, but when found in boys, the condition could be more severe.

Degenerative scoliosis is due to asymmetrical spine degeneration. It may occur in someone with idiopathic scoliosis when they were young or just occurs as a person gets older.

Preventing scoliosis

Scoliosis is best prevented by stopping progression through:

• Regular screening for scoliosis
• Treatment of the underlying diseases of the spine
• Neuromuscular retraining exercises

Many signs of scoliosis are noticeable and can be discovered in early childhood. These include:

• ‘S’-shaped curve in the back when standing
• A tilt in the waistline
• Curving of the body to one side when viewed from the front or back
• One breast appearing higher than the other in women
• One shoulder that appears higher than the other

Scoliosis is usually found in school children during health screening by nurses who look for unevenness of the torso when the child bends forward.

Your doctor will perform a physical exam to check for spine curvature to determine if you have scoliosis. In some cases, imaging tests may also be necessary to further investigate your condition.

Physical Examination

During a physical examination, you will begin by standing still with your arms at your sides. You will then be asked to bend forward as your doctor check for spine curvature in your lower and upper back. Your shoulders and waist will also be examined if they are symmetrical.

X-ray

X-ray is a diagnostic procedure that uses small amounts of radiation to create a picture of your spine. Radiography is used both to confirm the scoliosis and rule out any underlying conditions.

MRI scan

Your doctor may recommend MRI if you experience pain weakness or loss of reflexes. An MRI can help rule out tethered cord syndrome and congenital malformations such as a syrinx and/or Chiari malformations.

Treatment for idiopathic scoliosis may include:

• Wearing a brace to prevent worsening of the spinal curve. This does not reduce the curve that is already present.
• Observation for mild curves less than 25 degrees

Treatment for degenerative scoliosis may include:

• Spine surgery, for growing children with curves that are greater than 40 degrees and for curves that are more than 50 degrees at any age. This is usually recommended to treat severe pain unrelieved by conservative means such as physiotherapy, bracing and medication, and nerve impingement from degenerative changes in the spine. It also helps:
  • to prevent further worsening of the curve
  • to control the curve when brace treatment is unsuccessful
  • to improve the cosmetic appearance
  • to reduce discomfort or postural tiredness

Scoliosis cannot be corrected by simply learning to sit or stand up straight. Consult a specialist to determine the treatment method most suitable for you. At Mount Elizabeth Hospitals, our experienced orthopaedic consultants and surgeons are supported by a comprehensive team of nurses and physiotherapists to provide you with suitable treatment options.

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While scoliosis is not a life-threatening condition, it can present various complications in the long run, especially if left untreated. There is also the risk of complications that arise from surgery. The complications may include:

• Lung and heart problems

  Severe scoliosis can lead to breathing and heart problems as spine curvature may cause the rib cage to press against the lungs and heart.

• Chronic back pain

  Having scoliosis as a child puts you at a higher risk of developing chronic back pain.

• Visible physical changes

  Severe scoliosis may result in visible changes in the body such as uneven hips and shoulders.

• Osteopenia

  Scoliosis is related to osteopenia, a condition characterised by loss of bone mass, which puts you at risk for osteoporosis.

There is also the risk of complications that arise from surgery. These may include:

• Spinal fluid leakage

  Spinal surgery can damage the dura, the outermost layer of the meninges. This can lead to cerebrospinal fluid leak or spinal fluid leak. If left untreated, spinal fluid leakage leads to headache, visual disturbances, nasal drainage, meningitis (inflammation of the meninges), and tinnitus (hearing noises without external sources of sound).

• Nerve damage due to surgery

  Spinal fusion, a surgery that aims to reduce the curvature of the spine, can damage the spinal nerves and cause numbness in the legs or loss of lower body function.

• Possible infection after spine surgery

  Infection after spine surgery can happen on the incision area or in the spinal column. It can lead to swelling or redness and pus around the incision area, excessive drainage from incision area, and fever.