Most people expect their spine to be perfectly straight when viewed from behind, but for some individuals, this isn't the case. Scoliosis, a condition where the spine curves sideways, affects roughly 3% of the population, though only about 0.5% will ever require treatment. Consultant orthopedic surgeons Dr. Deepak Ajit Singh and Dr. Tan Jin Aun from Sunway Medical Damansara explain that the condition can manifest as either a single C-shaped curve or a double S-shaped curve.
According to Dr. Tan Jin Aun, any spinal curvature exceeding 10 degrees is considered scoliosis. The curve typically becomes visible once it reaches 20 to 30 degrees, often accompanied by a slight rotation of the vertebrae. In most cases, the exact cause remains unknown, a form called idiopathic scoliosis. Other types stem from congenital abnormalities, neuromuscular disorders, or degenerative changes that occur with aging.
"Many people confuse congenital and idiopathic scoliosis," clarifies Dr. Tan. "Congenital scoliosis develops in the womb, while idiopathic scoliosis develops after birth with no clear reason." This distinction is crucial for understanding both the timing and potential treatment approaches for different types of the condition.
Scoliosis can affect anyone, but it most commonly appears during the growth spurt just before puberty, typically between ages 10 and 15. Dr. Deepak notes that about 80% of cases occur during this developmental phase. Early detection plays a critical role in management outcomes, which is why Malaysia has been conducting school screenings for scoliosis since the late 1990s.
Interestingly, Dr. Deepak's master's thesis contributed to this nationwide screening effort. "We screened 10,000 schoolchildren in Kuala Langat District back in the 1990s to get local data on scoliosis, and that study eventually influenced the national school screening program," he recalls. This research helped establish the foundation for early detection programs that have improved treatment outcomes across the country.
Because scoliosis develops slowly, it often goes unnoticed until physical changes become apparent. Parents and caregivers should watch for uneven shoulders or hips, or clothes that don't hang evenly on the body. Dr. Tan emphasizes that children rarely experience pain from scoliosis, but if they do, it's important to rule out other serious causes, such as spinal tumors.
Mild scoliosis often goes unnoticed by both patients and their families. "Once the curve reaches 30 degrees, it becomes obvious. At 40 degrees or more, treatment is usually necessary," explains Dr. Deepak. However, severe cases can cause more than just cosmetic concerns. Large curves can lead to chronic back pain, muscle imbalances, breathing difficulties, and can significantly affect a person's self-esteem and quality of life.
Diagnosis begins with a comprehensive physical examination and X-rays to measure the precise degree of curvature, which serves as the primary factor in treatment planning. The treatment approach depends on several key factors: the size of the curve, the patient's age, and how rapidly the condition is progressing. In adolescents, medical professionals monitor growth patterns closely, as girls tend to develop progressive curves more frequently than boys.
Dr. Tan explains the treatment timeline: "If the curve is below 45 degrees when skeletal growth is complete, it usually won't worsen and doesn't need surgery. However, curves exceeding 45 degrees at skeletal maturity often require surgical correction." This is because even after growth stops, these larger curves can continue worsening by approximately one degree per year.
"Surgery isn't cosmetic; it prevents the curve from progressing and causing complications later," emphasizes Dr. Tan. Modern scoliosis surgery involves spinal fusion using metal rods and screws to straighten and stabilize the spine. Thanks to advances in technology and surgical techniques, these procedures have become much safer with better correction rates and faster recovery times.
For older adults, treatment goals may differ significantly from those for younger patients. "Instead of correcting the curve, we focus more on relieving pain and maintaining mobility," explains Dr. Deepak. This approach recognizes that the priorities shift as patients age and their bodies adapt to existing curves.
Many patients and families ask about bracing, which involves wearing corset-like devices for several hours daily. Dr. Deepak clarifies an important misconception: "Bracing doesn't correct the curve. It helps control it and improves balance, but it doesn't stop progression." Physical therapy can help maintain muscle strength and flexibility, though certain activities should be modified.
Regarding physical activities, Dr. Deepak suggests avoiding sports that involve significant twisting motions, such as tennis or golf, and recommends swimming as an excellent alternative. The emotional well-being of patients, particularly teenagers, requires careful attention as well. A scoliosis diagnosis can be worrying, especially during the already challenging adolescent years.
Despite these challenges, most people with scoliosis can lead full, active lives, especially with early diagnosis and proper medical care. "Parents shouldn't panic," advises Dr. Deepak. "Focus on your child's well-being and follow-up appointments. The vast majority will not need surgery." Both specialists emphasize that with proper reassurance and appropriate medical guidance, most cases of scoliosis are highly manageable.
The key to successful scoliosis management lies in early detection, regular monitoring, and maintaining open communication between patients, families, and healthcare providers. While the condition can seem daunting initially, the combination of improved screening programs, advanced surgical techniques, and comprehensive care approaches means that individuals with scoliosis have better outcomes than ever before.
