A doctor measures a patient’s spine using a pedi-scoliometer, which shows the curvature of the spine in degrees, for scoliosis. — Handout
Scoliosis is a condition where a patient’s spine exhibits an abnormal lateral curvature, most commonly forming a C- or S-shape.
In Malaysia, a study indicates that around 2.55% of Malaysians aged 13 to 15 have been diagnosed with scoliosis.
However, contrary to popular belief, scoliosis can also affect adults, significantly impacting their quality of life.
For adults, scoliosis can appear in two ways.
The first type actually starts in childhood or adolescence.
These patients develop scoliosis while young, but the condition initially doesn’t cause any problems.
However, as they grow older, the scoliosis becomes more severe and starts causing problems.
This is known as adult idiopathic scoliosis.
Spine surgeon Dr Saw Lim Beng explains: “From my experience, about 50% to 70% of children with idiopathic scoliosis have a minor spinal curve of less than 20 to 30 degrees.
“This group of scoliosis patients will typically be observed by the doctor with regular follow-ups to monitor their spinal curve and treat any issues they may face due to their condition.
“The scoliosis becomes severe due to the degenerative process and becomes symptomatic at late adult age.”
Meanwhile, the second form of adult scoliosis is called de novo scoliosis.
This develops in adulthood due to spine degeneration from ageing.
Both forms can significantly impact daily life if not properly managed.
Risk factors and diagnosis
The risk factors for developing adult scoliosis include a lack of paraspinal muscle strength due to inadequate exercise, poor bone quality, overuse of the spine from labour-intensive work, poor back care or posture, and spine fractures at a young age.
The paraspinal muscles are the three muscles that run parallel to the spine and help maintain your posture and support the spine.
Says Dr Saw: “Adult patients with scoliosis often experience regular back pain or body imbalance.
“Common symptoms include back stiffness or pain, particularly in areas where the facet joints are compensating for the imbalance, leading to discomfort and soreness.
“In severe cases, scoliosis can result in complications such as spinal nerve compression, which may cause leg numbness, weakness and difficulty walking.
“When the thoracic spine is involved, it can lead to reduced exercise tolerance and respiratory distress.”
“To accurately diagnose scoliosis, an X-ray is the best tool as it allows for measuring the Cobb’s angle to determine the severity of the condition.
“Additionally, a spine magnetic resonance imaging (MRI) analysis is conducted to assess any nerve compression.
“These diagnostic tools are crucial for evaluating the severity of scoliosis and for tailoring a treatment strategy with spine surgeons.”
Individualised treatment
For adult scoliosis, treatment is often tailored based on the patient’s profile, as this is vital for effectively managing the condition.
By customising treatment plans to the specific needs and conditions of each patient, healthcare professionals can optimise outcomes and enhance the patient’s quality of life and expectations.
This personalised strategy considers various characteristics of each patient, including the severity of the spinal curvature, age, overall health status, bone quality, lifestyle habits and specific symptoms.
This includes conservative treatment or advanced surgical treatment.
Conservative approaches often involve physiotherapy or exercise like swimming, pilates and yoga to improve spinal flexibility and strength.
Medication is also used to relieve pain or muscle tension.
These methods aim to alleviate pain and improve the quality of life without undergoing surgical intervention.
Most patients are able to live a quality life with these treatment options.
However, surgical intervention is needed in some cases of adult scoliosis with some careful consideration.
Says Dr Saw: “For scoliosis in adults, surgery is not the sole solution to alleviate scoliosis-related discomfort.
“Surgery can limit spine mobility due to the fixation of the spine, so it is not recommended for patients with mild curves or symptoms.
“However, in cases of severe spinal curvature or significant neurological symptoms, the benefits of surgery may outweigh the risks, making it a recommended option.”
In today’s world, advanced equipment and surgical techniques can assist spinal surgeons in several crucial aspects of the procedure.
These include precise monitoring of nerves and neurological function during surgery, and enhanced accuracy of inserting pedicle screws during the operation.
In cases with severe osteoporosis, cement-augmented pedicle screws allow stronger fixation to bone, compared to conventional pedicle screws.
For symptomatic patients who are not keen on major surgical intervention, various pain modulation procedures are available.
These include radiofrequency ablation, epidural steroids and various pain-block procedures.
These treatments allow symptomatic control in the short to moderate term.
However, if the patient’s condition becomes too severe, they will need to go for surgery in the end.
In summary, early detection, comprehensive management and ongoing monitoring are crucial in mitigating the progression of scoliosis and improving overall health outcomes.
Dr Saw recommends regular check-ups (at least once every two years) and exercises to maintain spinal flexibility and muscle strength, which can prevent severe complications and enhance the patient’s quality of life.
Additionally, a combination of vitamin D and calcium supplements can help strengthen bones and reduce the risk of fractures and scoliosis progression.
