Scoliosis is a condition where the normally straight spine curves or twists to form a C or S shaped curve. The prevalence of scoliosis is the highest during the growth spurt years, between the ages of 9 and 15. Early onset scoliosis (EOS) is scoliosis which is diagnosed before the age of 10, or before puberty.
It is diagnosed when the curvature of the spine is greater than 10°.
Children with early onset scoliosis still have plenty of growth remaining in the chest and spine, so treatment usually focuses on both controlling the progression of spinal deformity while also allowing the spine and chest to grow.
Signs of Scoliosis
Many signs of scoliosis are noticeable and can be detected in childhood. These include:
- “S”-shaped curve in the back when standing
- Curving of the body to one side when viewed from the front or back
- One shoulder that appears higher than the other
- A tilt in the waistline
- In females, one breast may appear higher than the other
How Common Is Scoliosis?
Scoliosis affects children of all races but is more common in girls than in boys (ratio of 7:1).
In Singapore, the prevalence of adolescent idiopathic scoliosis (ages 10-18) in schoolgirls is 1.4 percent at 11 to 12 years of age and 2.2 percent at 13 to 14 years of age.
Thus, the older the child, the higher the prevalence of scoliosis.
Diagnosing scoliosis
Scoliosis in schoolchildren is commonly detected during screening in schools by nurses who observe for asymmetry of the trunk when the child bends forward (known as Adam’s forward bend test).
In the Adam’s forward bend test, the child has to remove his/her shirt and bend forward, as if they are diving. If the child has scoliosis, his/her back often has a prominent line where the spine is, and one side is higher than the other. The back is completely straight in the absence of scoliosis.
In case of suspected scoliosis, your doctor might recommend:
- X-rays
- MRI scan in some cases
- CT scan might be used in case of congenital scoliosis, but must be weighed against risk of radiation to a young child.
Types of early onset scoliosis
There are several types of early onset scoliosis that are commonly recognised, including:
- Idiopathic scoliosis
- Neuromuscular scoliosis
- Syndromic scoliosis
- Congenital scoliosis
- Scoliosis associated with tumors, infection, prior surgery or trauma
Idiopathic early onset scoliosis
Idiopathic early onset scoliosis is scoliosis that occurs without an identifiable cause. It is by far the most common type of early onset scoliosis.
- About 80 to 90% of infants with early onset scoliosis will not require treatment to stabilise their spine curvature. The condition is less likely to progress in children younger than age 2 with infantile idiopathic curves less than 35 degrees. The curvature naturally straightens out with normal growth.
- A small number of infants and toddlers will unfortunately have progressive idiopathic scoliosis, which means their spinal curve will continue or worsen as they grow. It is seen that idiopathic EOS with curves greater than 30-35 degrees are likely to progress.
- In almost all cases, a specialist will perform an MRI of the spine to confirm that there is no underlying issue causing the scoliosis.
PHOTO: AAP
Congenital scoliosis
Congenital scoliosis is a type of scoliosis that you are born with. Congenital Scoliosis occurs in a foetus when vertebrae (bony portions of the spine) fail to form properly or segments fuse together.
Syndromic scoliosis
Syndromic scoliosis is associated with specific underlying syndromes and genetic conditions. Examples of syndromes that can be associated with early onset scoliosis include:
- Neurofibromatosis
- Spinal muscular atrophy
- Prader Willi Syndrome: a rare genetic disorder that causes obesity, intellectual disability, and shortness in height.
- Trisomy 21 (Down syndrome)
Neuromuscular scoliosis
Neuromuscular scoliosis is due to conditions that primarily affect the muscular and/or nervous system.
These include:
- Cerebral palsy
- Spinal muscular atrophy
- Muscular dystrophy: a disease that causes progressive weakness and loss of muscle mass
- Myelomeningocele (spina bifida)
How scoliosis affects your life
In severe cases (curves that are more than 80 to 90 degrees), the rib cage may press against the lungs and heart causing complications such as:
- Breathing problems
- Lung and heart damage
- Nerve damage
- Persistent back pain
How is early onset scoliosis treated?
Contrary to popular belief, scoliosis does not come from carrying something heavy like a backpack, or from bad posture. Hence the condition cannot be overcome by correcting posture. Also, food, vitamin supplements and exercise programmes have not been found to be helpful in treating the condition or halting its progression.
Physical therapy, massage, acupuncture and chiropractic care can help some patients with back pain. But there is no scientific evidence to show that they can prevent progression of the curve or improve the curve.
Scoliosis can be mild, moderate or severe. Your doctor will analyse the size and type of the curve, how much growing the child has left to do, and if the child has any other medical conditions. Treatment may include one or a combination of the following:
Observation
This non-surgical treatment of scoliosis involves observing the spinal curve with regular examinations and follow-up X-rays.
Curves that are less than 25 degrees can be observed at four- to six-monthly intervals.
A growing child who has a curve greater than 25 degrees will require treatment. A brace may be used to treat progressive curves or curves more than 25 degrees.
Bracing
Sometimes, wearing a brace is effective for curves between 20 and 40 degrees, in growing children. Bracing is designed to stop the progression of the spinal curve, but it does not make the already existing curve smaller.
10-year old boy with EOS (early onset scoliosis) in his brace. PHOTO: ResearchGate
Surgery
Surgery is recommended for growing children with curves that are greater than 40 degrees and for curves that are more than 50 degrees at any age.
Surgical treatment of scoliosis may be recommended these reasons:
- To prevent further progression of the curve
- To control the curve when brace treatment is unsuccessful
- To improve an undesired cosmetic appearance
- For reasons of discomfort or postural fatigue
The most common surgical treatment for scoliosis is a spinal fusion using special stainless steel/titanium rods, hooks, screws and bone graft to carefully straighten the curved portion of the spine.
(Source: Children’s Hospital Colorado, AAP, SingHealth)
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