Prevention and early detection of scoliosis in children and adolescents

Scoliosis: the hereditary spinal condition in which the spine curves to one side, taking after the shape of an “S” or “C,” is often misbelieved to be the result of bad posture, and, in children, caused by carrying heavy bags – neither are true.

Although most cases of scoliosis have no known cause (idiopathic scoliosis), early detection is recommended to prevent it from causing serious detriment to a person’s health, according to Dr. Wong Chung Chek, Consultant Orthopaedic and Spine Surgeon at ALTY Hospital (ALTY) in Kuala Lumpur.

Scoliosis is said to affect about 2-3% of the population in Malaysia. It is most often detected during adolescence, but can also affect adults and the elderly, albeit at a lower rate.

As scoliosis can worsen very quickly during childhood growth spurts and adolescence, parents should make it a point to examine their children on a regular basis. Scoliosis progresses very rapidly during these growth spurts and only slows down or stops once the child reaches bone maturity.

Signs of scoliosis become more noticeable as a child grows in age or as the curve progresses, but that doesn’t mean that scoliosis is impossible to notice early.

Parents can look out for any imbalances in the height or position of shoulders, shoulder blades, or hips — for example, one shoulder appears to be consistently drooping below the other. Parents should also watch for protruding shoulder blades, unevenness in gait, or misalignment of the head with the rest of the body, as these are all common symptoms of scoliosis.

In addition to home surveyance by parents, it is recommended to have posture screening for children in schools, together with regular health screenings. This will help to identify any symptoms earlier, especially since most children are developing rapidly at this time, which is typically when scoliosis begins to occur; and raise awareness about the condition, at the same time.

Recently, ALTY organised a Community Scoliosis Screening campaign – with pharmaceutical business, Viatris – around Klang Valley which resulted in over 250 walk-ins. From the screening sessions, it was discovered that a majority of parents and guardians were unsure of what signs to look for in their children, especially concerning scoliosis.

Most were also unaware that posture screening is available at most health clinics that can highlight growth or development related issues in children.

Dr. Wong said that one away to ensure early detection of scoliosis in children is to make early screening accessible in schools. School authorities and government collaborations can be considered in the future to ensure that posture screening is included as part of regular health assessments for Malaysian children.

However, if you are still unsure, it is best to consult an orthopaedic specialist as soon as possible. An orthopaedist who specialises in paediatric conditions will be able to examine spinal curvatures in children or recommend preventive measures as necessary.

While scoliosis is not a preventable condition, measures can be taken for early detection that can slow down the worsening of the condition, thus avoiding surgery. Even in situations where surgery is still needed, early detection would translate to shorter segments and safer surgeries.

Early detection for Scoliosis to avoid surgical treatment

Early detection of Scoliosis or sideway curvature of the spine can reduce the potential for surgical treatment, said an orthopaedic surgeon and consultant at ALTY Hospital, Dr Lim Sze Wei .

As such, he expressed the need to expand the awareness programme on the disease, especially at the school level, as the critical age for the disease is between 10 to 14 years.

“Usually, the awareness programme is carried out in the urban areas, rarely done in rural schools. That’s why most teenage patients come to us when their bones are already bent,  at 60 to 70 degrees, which usually can be treated only through surgery.

“This is because at the age of 10 to 14, bone movement occurs more rapidly. If detected early, at below 40 degrees, brace treatment and regular monitoring can be done without the need for surgery,” he told Bernama after the Scoliosis Awareness Day program organised by the Malaysian Scoliosis Support Group today.

According to him, the Scoliosis awareness program being conducted in the community by conducting health checks is still not enough.

“That is why, we have parents seeking traditional treatment or going to shaman or bomoh to treat their children who have crooked spine, and only go to the doctor when the child’s condition has worsened, with the spine curved up to 90 degrees, making the treatment more difficult,” he added.

Dr Lim said the cost for scoliosis surgery in private hospitals could reach up to between RM70,000 and RM80,000.

“This disease is more likely to affect women than men, and until today it is still not possible to determine the cause,” he said.

A former Scoliosis patient Nur Fadzilah Rahim, 28, said she was brought to see a doctor when she was detected having difficulty in doing physical education activities during her school days.

“I was 16 years old when I noticed my body shape was different, but I thought it was normal, as I didn’t feel any pain. It was only while doing physical education activities, my teacher noticed that could not do the exercise like the other students. The teacher notice a bend in my body and asked me to see a doctor.

“It was when I saw the doctor that I was diagnosed with Scoliosis, but it was not severe at that time and the doctor recommended that I did physio only,” she said.

However, she said, her spine continued to bend which made it difficult for her to walk and had to use a wheelchair.

She said she also suffered from shortness of breath as Scoliosis had a significant effect on the respiratory function.

“In 2013 when the curvature of my spine was at 50 degrees, I finally underwent surgery that cost about RM36,000 at the Kuala Lumpur Hospital and because my late father was a former soldier, we managed to get funds from the Malaysian Armed Forces Veterans Association for the surgery,” she said.

Nur Fadzilah said it was due to Scoliosis that she had to postpone her studies after completing her Sijil Pelajaran Malaysia. It took her a year after the surgery to be able to continue with her studies.

Meanwhile, Malaysian Scoliosis Support Group chairman Rasidah Md Sapie, who has a child with Scoliosis, said there was a need top enhance public awareness on the disease.

“Scoliosis is not a popular disease, although many people suffer from it. My child was 12-years-old when I got to know about the disease.

“Initially, I did not know the problems affecting my child, who gets tired easily when having to walk for some distance,” she said. – Bernama