What is scoliosis?

Scoliosis is the abnormal curvature or twisting of the spine (backbone). It can affect people of all ages, from infants to adults, but typically begins in children between 10 and 15 years old.

Everyone's spine is somewhat curved by nature. However, those with scoliosis have an overly curved spine that could resemble the letters C or S.

Scoliosis is broadly categorised as follows:

1. Structural

   As the name suggests, it affects the spine's structure and is a permanent condition until appropriate treatment is received. It is more commonly occurring (than non-structural) and may involve spinal rotation or side curvature of the spine.

   Structural scoliosis is further divided into the following types:

   • Idiopathic scoliosis: It is the most common form of scoliosis. The cause is unknown but may be attributed to certain genetic factors.
   • Degenerative scoliosis: Also known as adult scoliosis, it occurs later in life due to bone conditions that cause the spine to degenerate.
   • Neuromuscular scoliosis: Also called myopathic scoliosis, it occurs due to poor posture in individuals with neuromuscular conditions like cerebral palsy or muscular dystrophy.
   • Congenital scoliosis: This is a rare condition that results due to vertebral malformations in utero.

2. Non-Structural

   Also known as functional scoliosis, this is usually due to temporary causes and is likely reversible as it may be caused by conditions such as muscle pain or spasms.

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What are the symptoms of scoliosis?

Following are some notable symptoms of scoliosis:

• A visibly curved spine
• One hip appears more prominent than the other
• Uneven-looking shoulders
• One side of the rib cage appears to be protruding forward

Other symptoms include:

• Back pain
• Stiffness in the lower back
• Numbness in one or both legs

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What are the causes of scoliosis?

In approximately 8 out of 10 cases, the cause of scoliosis is unclear, and this is known as idiopathic scoliosis.

Other medical conditions account for a small number of cases, and these include:

• Cerebral palsy
• Muscular dystrophy
• Neurofibromatosis
• Marfan syndrome

Adults may develop scoliosis due to age-related changes in the discs and joints of the spine, as well as a decrease in bone density. Undiagnosed or untreated scoliosis in adults can also worsen with time if left untreated or undiagnosed.

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How is scoliosis diagnosed?

Diagnosis is made based on the reported signs and symptoms, physical examination, and investigations.

You may be asked to bend forward to determine if there are particularly prominent areas, as this makes your spine more visible. In the early stages of scoliosis, it may be difficult to notice changes.

Imaging tests:

• X-rays: Done to determine the angle, shape, direction, and location of the curvature.
• Magnetic resonance imaging (MRI): A doctor may want to conduct MRI to rule out spinal cord abnormality.

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How is scoliosis treated?

In children:

Your child's scoliosis treatment will depend on their age and the severity of their condition. Treatment options include:

1. Observation

   • As the condition may correct itself as children grow, treatment is not always necessary.
   • Your orthopaedic specialist would closely monitor the condition.

2. Casting

   • Done in children under the age of two.
   • A cast is an external trunk brace made from a combination of lightweight plaster and advanced casting materials.
   • It has to be constantly worn and cannot be removed. However, the case is changed regularly to allow for growth and remodelling.

3. Bracing

   • The doctor may recommend a back brace for your child while they are growing (over 10 years old).
   • Although a back brace cannot correct the curve or cure scoliosis, it may prevent the curve from worsening.

4. Surgery

   • Corrective surgery may be advised if your child's scoliosis is severe and other therapies have failed.
   • The type of surgery will depend on the age of your child.

In adults:

In adults, treatment is mainly aimed at pain relief, as back pain is a common complaint of scoliosis. In certain cases, surgery may be required to improve the shape of the spine in order to alleviate back and leg pain.

Treatment options include:

1. Conservative
   • Appropriate for patients without “red flag” findings (clumsiness, progressive weakness, radiating extremity pain, numbness or loss of bowel or bladder control).
   • To maintain or improve quality of life, function, and stamina instead of correcting spinal deformity.
   • Analgesics to manage pain.
   • Physiotherapeutic scoliosis-specific exercises (PSSE).
   • Soft bracing for spinal support.
   • Weight loss for overweight patients.
   • Four-wheel rolling walker with seat and brakes to improve mobility, reduce risk of falls and decrease pain.
2. Surgery
   • Recommended if the scoliosis is severe or progressively worsening.
   • To improve the patient's quality of life and self-image by reducing pain and neurologic symptoms and maintaining or restoring three-dimensional spinal balance.
   • Types of surgery:
     • Decompression surgery
     • Spinal fusion surgery

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What are the types of scoliosis braces?

To maximise the effectiveness of a scoliosis brace, one must:

• Ensure that the measurements taken before customising the brace are accurate.
• Wear it correctly and for the recommended amount of time every day.
• Get it corrected for revisions if it does not fit perfectly.

A well-constructed brace can be worn for 18 hours daily and does not limit daily activities, including exercises and sports.

Based on the coverage provided, there are two types of scoliosis brace:

1. Thoracic-lumbar-sacral orthosis (TLSO)

   • Underarm brace and goes up to the buttocks.
   • Comparatively easy to conceal beneath clothing and generally accepted by the majority of patients.
   • Boston brace: Most commonly used. It works by applying corrective force on the outer side of the curve.
   • Charleston bending brace: Worn only at night. The Charleston bending brace is designed to be worn while lying down, not standing or walking. As a result, the brace may be able to apply higher forces.
   • Providence brace: Similar to Charleston brace. Providence brace lifts one shoulder slightly and applies direct lateral and rotational forces to the curve.

2. Cervical-thoracic-lumbar-sacral orthosis (CTLSO)

   • A small percentage of patients with scoliosis require an under-chin extension brace.
   • Difficult to conceal under clothing and poorly tolerated by patients.
   • Milwaukee brace: Primarily a thoracic support with a pelvic corset connected by adjustable steel that supports to a cervical ring holding occipital (back of the head) and chin pads; intended to prevent lumbar lordosis and encourage effective stretching and straightening of the thoracic spine.

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FAQs: Scoliosis bracing effectiveness

1. Does bracing help scoliosis?

   In most cases, braces only work to stop the worsening/progression of spinal curvature.

2. What degree of scoliosis requires a brace?

   Bracing is suggested as a treatment option when:

   • Cobb angle is 20 to 40 degrees.
   • Cobb angle is 20 to 24 degrees with a progression of more than 5 degrees.
3. What kind of brace is best for me?

   Your orthopaedic specialist will determine which brace best suits your condition. It will depend on the following factors:

   • The locations of curvature on your spine
   • The degree of curvature
   • The number of curves
   • The flexibility of the curve
   • Other medical conditions
   • Lifestyle
4. Does physical therapy help with scoliosis?

   Certain physical therapy methods may improve the curve and strengthen the surrounding muscles. However, there is no scientific evidence to suggest that physiotherapy on its own is sufficient to halt the progression of scoliosis.

5. What are the types of exercises recommended?

   Scoliosis-specific exercises (e.g., Schroth, Scientific Exercises Approach to Scoliosis) typically give three-dimensional self-correction and stabilise corrected postures.

   It is vital to understand that exercises will not stop the progression of scoliosis. You may still need to wear the brace as advised by your doctor.

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Book an appointment at Pantai Hospitals

Speak to your doctor if you would like to know more about scoliosis and bracing. Early detection of scoliosis makes treating the condition easier with effective and appropriate treatment.

A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance. 

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