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Paediatric scoliosis: Take one step ahead of the curve
Lifestyle

Paediatric scoliosis: Take one step ahead of the curve

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    Published on 9 October 2022

    Scoliosis affects 2% of the population, with the majority of cases diagnosed during childhood. How does the condition affect children and how can we manage it?

     

    Scoliosis is a condition that causes the abnormal curvature of the spine. While it can be recognised as early as in utero, this spinal deformity is most commonly diagnosed during childhood or adolescence when growth spurts occur. “Paediatric scoliosis is a growing disorder of the spine, where a normally straight spine, when viewed from the front or back, grows sideways, forming either an ‘S’ or ‘C’ shaped spine. The asymmetrical growing of the spine creates an unevenness of the body surfaces, resulting in shoulder imbalance, rib prominence, and waistline asymmetry,” explained Dr Lau Leok Lim, Senior Consultant, Division of Spine Surgery, Department of Orthopaedic Surgery, National University Hospital (NUH). The causes of paediatric scoliosis are largely unknown, but three main types have been identified in children: • Idiopathic scoliosis: The most common type of scoliosis in children. The reason for this occurrence is unknown. • Congenital scoliosis: The individual bones are not formed or separated properly from birth. • Neuromuscular scoliosis: Caused by underlying medical conditions that affect the muscles or nerves, such as muscular dystrophy or cerebral palsy. Additionally, the most common form, idiopathic scoliosis, can be further sub-categorised based on the age of the patient when the condition occurs: • Infantile idiopathic scoliosis: from birth to three years • Juvenile idiopathic scoliosis: from three to nine years • Adolescent idiopathic scoliosis: from 10 to 18 years “The most common diagnosis encountered is adolescent idiopathic scoliosis, which is present in 2% of our population. Scoliosis is most commonly diagnosed during growth spurts. For girls, this is often between the ages of 11-14, and for boys, between 13-16,” said Dr Lau. Awareness and detection Early detection is key for patients with any form of scoliosis, as it determines the suitable course of action. “The management strategies differ substantially among the types of scoliosis. In infantile scoliosis, some of the curve patterns are reversible with appropriate treatment, including body casting or a brace,” shared Dr Lau. “[Whereas] in juvenile scoliosis, observation or a brace may be recommended. In more severe situations, growth-friendly technologies such as magnetic driven growing rods may also be recommended to control the curve and prevent it from getting worse.” As scoliosis in children rarely causes any back pain, it may be tricky to notice the symptoms. Dr Lau advised parents and caretakers to look out for signs in their children, such as asymmetrical shoulder blades or waistlines. Important:            Parents seek professional advice should they suspect the presence of scoliosis Warning signs to look out for Asymmetrical shoulder blades Asymmetrical waistlines Abnormal rib protrusion In females, one breast  may appear higher than the other Scoliosis is commonly diagnosed during growth spurts Boys Age: 13-16 Girls Age: 11-14 Idiopathic Congenital Neuromuscular Least common type Present at birth Individual spinal bones are not formed/separated properly Worsens with growth Most common type Can occur during infancy       adolescence Condition often worsens during growth spurts A  symmetrical pull of muscle   forces around the spinal structures Commonly affects patients with underlying muscle or nerve conditions (cerebral palsy or muscular dystrophy) Some patients may be wheelchair-dependent Population statistics 7/10 are female 2 % population have scoliosis of the There are 3 main types of paediatric scoliosis He also encouraged parents and caretakers to seek professional advice if they suspect that their child is affected by any form of scoliosis. 

    However, it’s not all doom and gloom even if your child has the condition. “90% of patients have mild scoliosis without any real need of intervention. The remaining 10% of patients would require specialist care for more watchful observation, a brace, or surgery,” said Dr Lau. 

    Types of treatment

    So how is paediatric scoliosis treated? 

    “After confirmation of diagnosis, the doctor would determine the severity of the scoliosis with the patient in a standing position using radiographs. Serial radiographs are required to monitor the progression of the curve during the growing phase of the child,” he said. “At NUH, we have two slot scanning machines that allow this to be done safely with minimal radiation. This is particularly suitable for children.”

    Developments in technology have also improved scoliosis treatment methods and efficacy. “Knowing that adolescent idiopathic scoliosis is a growing disorder, the latest management involves the use of bone-age – a type of x-ray that can accurately identify the growth spurt and stratify it to stages. The abnormal growth can be restrained with a rigid brace, with the right dose of ‘wear time’ to minimise the ill effects of bracing.” 

    In certain scenarios, including cases of infantile or adolescent idiopathic scoliosis, the condition may even be reversible. Dr Lau described a relatively novel surgery called Vertebral Body Tethering (VBT), which can be used to guide the abnormal growth of the spine, ‘normalising’ the curve without fusion, to achieve a relatively straight and flexible spine.

    Speak to your doctor to find out more about the treatment and management of paediatric scoliosis.

    In consultation with Dr Lau Leok Lim, Senior Consultant, Division of Spine Surgery, Department of Orthopaedic Surgery, NUH.

    Please download the full infographics here.

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