NEARLY one in 10 Singaporeans over 40 suffers from a degenerative spine condition that causes their lower back to bow, according to findings from a study released yesterday.

Doctors are hoping that the study, the first of its kind in Asia, will help them determine what causes lumbar scoliosis – a condition that makes the lower spine curve sideways. It can eventually lead to back and leg pain, making it hard for patients to walk.

Conducted by a team of spine surgeons at National University Hospital (NUH), the study revealed that 9 per cent of those aged 40 and above have the condition.

This is the first large-scale study done in Asia and is in line with a study carried out in North America, which showed similar results.

Although the numbers are not alarming, the condition could become more prevalent as the population ages, said Professor Wong Hee Kit, chairman of the Orthopaedics and Hand & Reconstructive Microsurgery Cluster at National University Health System (NUHS).

He said that scoliosis in older patients results from wear and tear on the spine. It can compress nerves and cause back pain.

‘A patient could get intense pain just from walking long distances, shopping or even taking their grandchildren to school,’ he said.

Researchers examined scans done on the lower backs of 5,500 random patients over 21/2 years.

They found that four times more patients in their 80s had lumbar scoliosis than those in their 40s. The study also revealed that the condition is 1.6 times more common in females.

It also surfaces more than twice as often in Chinese and Malays than Indians.

‘Once we have an idea of prevalence, we can then start to identify patients and find out why some are pre-disposed and some are not,’ said Prof Wong.

The findings were revealed during the opening of the University Spine Centre at NUH. It was opened officially by the Ministry of Health’s director of medical services, Professor K. Satkunanantham.

The new centre, which opened its doors in March, has combined NUH’s spine services under one roof.

A team of five full-time spine surgeons will manage the centre on a rotational basis and provide services like physiotherapy, X-rays, pre-surgery assessments and counselling.

Intensive rehabilitation Programme for scoliosis
by the Katharina Schroth method

Three Dimensional Therapy for Scoliosis by the Katharina Schroth method Individual treatment for scoliosis with a well proven exercise programme (treatment according to the individual curve pattern, in groups and individual sessions with and without special exercises to elongate and derotate trunk and spine)

FED-Therapy – a computer-guided compression therapy
mechanical pressure against the curvatures alternating with phases of relaxation

Specialized respiratory care – to increase restricted breathing capacity

Water exercises – training programme in the special training pool

Introduction of our patients in basic anatomy – to understand the orthopaedic background of Scoliosis and initiate improved postural patterns

Introduction to the individual exercises for the home therapy

Individual movement strategies for everyday life activities at school, at home and in the workplace

Accommodation and training for parents or relatives during the in-patient treatment of a child.

Custom-fitted braces as an additional corrective component if needed.

Balneotherapy and Physical Therapy such as mud wraps, massages, medical baths, electrotherapy
Additional Physiotherapy and techniques (pain treatment):

	Manual Therapy (Kaltenborn, Frisch, Maitland)
	PNF - activation and strengthening of supporting muscles
	FBL – technique to allow the patient close observation of posture and movement
	Brügger – stabilizing technique to reduce painful strain which is often the result of a scoliotic postural pattern
	Chiropractice – adjustment of distorted vertebrae by manual mobilization techniques
	Cyriax – mobilizing techniques for muscles and joints
	Osteopathy – specific technique to mobilize joints and to reduce pain
	Mc Kenzie - homeprogramme for patients with pain

As a teenager growing up in Belmont, Mass., Erin Mahony was, in her mother’s words, ”tilted like a teapot.” Because of a curvature of the spine called scoliosis, Erin’s right shoulder was several inches higher than the left, she limped and her left arm hung down so low that her hand could touch her foot.

Unlike most youngsters with scoliosis, whose condition first becomes apparent around the time of puberty, Erin was born with a spinal deformity that made three operations and many years of bracing necessary. But today, at 23, she stands straight without a brace, skis, plays tennis and hikes. She is a first-year medical student at Yale, with hopes of becoming a pediatrician.

Erin’s mother, Mary Mahony, recounts her daughter’s remarkable and inspiring medical journey in her 1997 book, ”What Can I Give You?”

A Common Condition

While the human spine is supposed to curve in a gentle ”S” from back to front, in some youngsters the spine also curves abnormally from side to side, the defining characteristic of scoliosis.

For reasons as yet unknown, scoliosis occurs far more often in girls than boys. One girl in 10 but only one boy in 25 has some degree of scoliosis. But most cases have little or no medical or cosmetic significance and never get any worse. In only 2 percent or 3 percent of cases the condition requires medical attention, which most often involves monitoring it periodically to determine if it progresses to a point that requires treatment.

Girls are seven times as likely as boys to develop serious spinal curvatures needing treatment, either with braces to halt progression or with surgery.

The six months before and after the onset of puberty — when girls start menstruating and boys’ voices deepen — is the time of greatest risk for progression of abnormal spinal curves. At that point, while the child’s bones are still growing, there is a narrow window of opportunity to take corrective action with bracing that may eliminate the need for surgery.

Earlier detection is critical. Pediatricians and family physicians should check for scoliosis at every visit, especially as a child approaches and passes through adolescence. At least 26 states now mandate screening for scoliosis in schools, a practice endorsed by the American Academy of Orthopaedic Surgeons. School nurses and even teachers can be trained to do a 30-second screening exam for spinal abnormalities.

Girls should be screened at ages 11 and 13, and boys at age 13 or 14, the academy says. But the Scoliosis Research Society recommends annual screening for all children 10 through 14. An annual exam in the years of rapid bone growth can make the difference between a preventable condition and a disability that will persist through adulthood.

Parents can also check their children’s spines periodically, as described below. If a parent has scoliosis, it is especially important that the children be examined; the condition runs in families.

”The key word in scoliosis is progression, to detect it at the outset and do what is needed to try to prevent it from getting worse,” said Dr. Richard Haynes, a pediatric orthopedic surgeon at Shriners Hospital for Children in Houston.

The good news is that only a minority of cases progress to the point where medical intervention is needed. Further good news: in most cases, treatment today — surgery as well as bracing — is less arduous than in years past. And the process of monitoring progression of the condition, which often involves periodic X-rays, is now much safer.

Contrary to the belief of some adults, scoliosis does not result from poor posture, bad eating or exercise habits, lack of calcium or carrying heavy book bags. Still, physicians have yet to figure out why so many youngsters develop it.

Most cases occur in otherwise healthy children. In only about 10 percent to 20 percent of cases is there an apparent underlying cause: an abnormality, present at birth, in the development of the spine, as happened to Erin; a spinal tumor; a neuromuscular disorder like polio or muscular dystrophy; a connective tissue disorder like Marfan’s syndrome; cerebral palsy; spina bifida; or radiation therapy to the spine.

Occasionally, a difference in leg length or abnormality in the hip may result in scoliosis as a child grows. Obvious scoliosis may also develop at times in adults as a result of earlier radiation therapy, degeneration of spinal disks, arthritis in vertebral joints, osteoporosis (a thinning of the bones) or osteomalacia (a softening of the bones).

A spine with scoliosis may have one or more curves from side to side. Most often the abnormality is at the level of the chest, but it may also occur in the lower lumbar region or in both parts of the spine.

In addition to causing cosmetic problems — uneven shoulders or hips, a protruding shoulder blade or slanted waistline and clothes that don’t hang right– severe scoliosis can have serious medical consequences, including pain, arthritic symptoms and heart and lung complications resulting from compression of one side of the chest.Any of those conditions can limit a person’s activities.

Perhaps most distressing to an affected child is that scoliosis becomes apparent just when youngsters are likely to be most self-conscious and concerned about their appearances. The National Scoliosis Foundation (800-673-6922) is a good source of free support and information that can be helpful both to an affected child and the child’s parents.

Checking Your Child

An excellent and comprehensive book about the condition is ”The Scoliosis Sourcebook.” Dr. Michael Neuwirth, director of the Spine Institute at Beth Israel Medical Center in New York, and his co-author, Kevin Osborn, suggest that parents check their preteen and teenage children for ”asymmetry,” the hallmark of scoliosis, ”once or twice a year, when your child is wearing just underwear or a bathing suit.”

The authors point out that ”although asymmetry in itself does not always indicate scoliosis, every scoliosis creates some degree of asymmetry apparent from the front or back.”

This is what a parent should look for:

*Does one hip or shoulder look higher than the other?

*Does one shoulder blade look more prominent or bigger than the other?

*Is the neckline uneven?

*Do a girl’s developing breasts appear to be unequal in size?

*Does the child’s head line up over the pelvis?

*When the child bends over from the waist, with knees together and straight and arms hanging down, is one side of the upper back higher than the other?

Call any abnormality to the attention of the child’s physician. An X-ray of the spine can reveal the presence and degree of scoliosis. A suspected case of scoliosis should be checked out by an orthopedic surgeon, preferably one who specializes in spinal disorders.

Sometimes periodic monitoring of a child’s spine is needed. If that’s the case, parents have little to be concerned about in terms of X-ray radiation; less is involved today than in years past, when frequent X-rays might have increased the risk of some cancers later in life.

Photo: Erin Mahony, who had scoliosis, is now 23 years old. She stands straight, skis, plays tennis and hikes.; Bent at the waist is one of several positions used in simple scoliosis screening. Symmetry of the upper and lower back is normal. Asymmetry suggests scoliosis.

-NY TIMES

5-year-old boy, scoliosis resulting from polio (left).
After 3 weeks of intensive Schroth treatment (center).
After 8 weeks of Schroth scoliosis exercise therapy (right)