Scoliosis: Symptoms, Diagnosis, Treatment

Our 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 the abnormal curvature or twisting of the spine (backbone).

Scoliosis is broadly categorised to structural scoliosis and non-structural scoliosis.

1. Structural: 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 can be divided into the following types:

   • Idiopathic scoliosis is the most common form of scoliosis. The cause is unknown but may be attributed to certain genetic factors.
   • Degenerative scoliosis or adult scoliosis occurs later in life due to bone conditions that cause the spine to degenerate.
   • Neuromuscular scoliosis or myopathic scoliosis occurs due to poor posture in individuals with neuromuscular conditions like cerebral palsy or muscular dystrophy.
   • Congenital scoliosis 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.

Scoliosis symptoms

Notable symptoms include:

• 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

Scoliosis diagnosis

Your doctor would first question your general health and symptoms before conducting a thorough physical examination.

Diagnosis is made based on your reported 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 test such as an X-ray is done to determine the angle, shape, direction, and location of the curvature. Magnetic resonance imaging (MRI) scan may be done to rule out spinal cord abnormality.

Scoliosis treatment options

For children

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

1. Your orthopaedic specialist would closely observe and monitor the condition as scoliosis may correct itself as children grow, treatment is not always necessary. 
2. Casting is 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 cast is changed regularly to allow for growth and remodelling. 
3. Bracing (back brace) may be recommended 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. 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.

For adults

In adults, treatment is mainly aimed at pain relief, as back pain is a common complaint of scoliosis. Treatment options include:

1. Non-surgical approaches
   • Analgesics to manage pain.
   • Physiotherapeutic scoliosis-specific exercises (PSSE) may improve the curve and strengthen the surrounding muscles.
   • 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. Surgical options
   • For example, decompression surgery or spinal fusion 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 scoliosis braces

There are two types of scoliosis brace:

1. Thoracic-lumbar-sacral orthosis (TLSO): Underarm brace and goes up to the buttocks. It is comparatively easy to conceal beneath clothing and generally accepted by the majority of patients.
   • Boston brace is themost commonly used scoliosis brace. It works by applying corrective force on the outer side of the curve.
   • Charleston bending brace is designed to be worn while lying down, not standing or walking. It is worn only at night. This brace may be able to apply higher forces.
   • 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. It is difficult to conceal under clothing and poorly tolerated by patients.
   • Milwaukee brace is 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. It is intended to prevent lumbar lordosis and encourage effective stretching and straightening of the thoracic spine.

Effectiveness of scoliosis bracing

Your orthopaedic specialist will determine which brace best suits your condition. It will depend on the locations of curvature on your spine, degree of curvature, number of curves, flexibility of the curve, other medical conditions, and lifestyle. In most cases, braces only work to stop the worsening/progression of spinal curvature. 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. 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.

Make an appointment at Gleneagles Hospitals

Speak to your doctor if you would like to know more about scoliosis and bracing. If you or your child experiences any of the symptoms of scoliosis, get in touch with us to find out more about ourOrthopaedic Servicesat your nearest Gleneagles Hospital.

Gleneagles Hospital works with orthopaedic specialists to assist patients through diagnosis and treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.