(From left) Scoliosis Support Singapore co-founder and president Jasmine Liew,with group members Nadia Tan and Aaron Yap. The group now has 216 members and they conduct meet-ups twice a year to give encouragement to those considering surgery. They also do bedside support for those about to have surgery. PHOTO: GIN TAY FOR THE STRAITS TIMES

Group provides support for patients dealing with scoliosis

Bending down to pick something up does not take much effort for most of us, but it is difficult for student Aaron Yap.

Mr Yap, 25, has to squat slowly to prevent hurting his back due to a debilitating affliction he has had since the age of four.

The graduating pharmacy student at the National University of Singapore has scoliosis, a condition in which a normally straight spine curves laterally.

His parents first realised there was a problem when they took him to a park. They noticed he was walking unevenly and that one of his shoulders was higher than the other.

A doctor who examined Mr Yap found his spine had a 60-degree curvature and recommended surgery to fuse his spine with metal rods to correct the problem.

But his young age and the risk that surgery might result in his body not being able to grow any further prompted his parents to hold off going for surgery for as long as they could.

However, Mr Yap had to wear a brace for 24 hours a day to minimise more spinal curvature.

“Wearing a brace every day was hot and uncomfortable – I even had to sleep and exercise with it. It was unbearable,” he said.

“I was also not able to do a lot of sports because of the brace. However, I knew why I had to wear it and I ended up accepting it as a part of my life.

“My family, classmates and school were very helpful during that period of time. My classmates would often help to carry my bag, my school would arrange for my classes to be on the first floor so that I didn’t have to climb the stairs with heavy books, and my mum would divide my textbooks into five parts so that I did not have to carry a heavy bag to school every day.

“I also often left my books in the lockers provided for us in school.” However, by the time he was 12, Mr Yap’s curvature had worsened to 110 degrees.

A curvature greater than 40 degrees is categorised as severe, said Associate Professor Kevin Lim, chairman of the division of surgery and senior consultant at the department of orthopaedic surgery at KK Women’s and Children’s Hospital.

Mr Yap’s parents decided that he should have an operation after sitting his Primary School Leaving Examination.

After surgery, Mr Yap had to relearn how to walk and had problems getting in and out of bed. It took three months of physiotherapy before he could finally regain full mobility.

His spinal curvature has stabilised at around 60 degrees.

“I feel one thing I really learnt from my experience is resilience. I feel I can persevere through difficult situations and take on challenges quite positively now,” said Mr Yap, who is a member of Singapore’s only scoliosis support group.

“As a member, I am able to share my story with others and show them that I am okay, even after surgery.

“My story helps to give others confidence and advice on dealing with scoliosis. I can also provide reassurance to parents with children who have scoliosis.”

Scoliosis Support Singapore cofounder and president Jasmine Liew, who also suffers from the ailment, said: “The support group was put together to connect scoliosis patients and to raise awareness about scoliosis.”

Ms Liew, 39, learnt that she had scoliosis when she was 13 and has since had three operations to treat her spine.

When she was diagnosed, she found there was not much information and few people available to talk to about the condition.

“When I went for my operation, I did not have any support and I didn’t know what to expect after my operation. It was quite difficult for me,” Ms Liew added.

She started Scoliosis Support Singapore in 2005 to provide sufferers with the support they need.

The group now has 216 members and they conduct meet-ups twice a year to give encouragement to those considering surgery. They also do bedside support for those about to have surgery.

One group member is landscape architect Nadia Tan, who was diagnosed with scoliosis at the age of 11 during a school health check-up in Primary 5.

“When I first found out I had scoliosis, I felt that something was wrong with me. However, I had a very supportive family who helped me feel that I wasn’t abnormal,” said Ms Tan, 24.

Within just a year, her spinal curvature increased from 10 degrees to 65 degrees.

During that period, Ms Tan had to wear a brace.

“I didn’t like it because it was so restrictive. The brace also gave me rashes and bruises on my hips from the friction. I then decided to wear the brace only at home and not when I was at school,” said Ms Tan.

At the end of 2005, she went for an operation and her spine now has a nine-degree curvature.

Like Mr Yap, she had difficulties getting out of bed and had to relearn how to walk after surgery.

It took about a week before she could regain full mobility.

She also had to give up dancing, which was her passion, as there were moves she could not do after surgery.

Now, she rarely gets backaches except when sitting for too long. She does pilates to help loosen and stretch her muscles.

Her words of encouragement for others with scoliosis: “Sometimes, talking to those who have gone through the process helps a lot. They can give you the courage to be strong.”

Scoliosis more common in females

KKH, SGH, CGH doctors on scoliosisScoliosis, a sideways curvature of the spine, can affect anyone, but females have a higher chance of getting it.

“The general incidence of scoliosis is about 2 per cent in Singapore. It is more common in girls than boys, with a ratio of seven to one,” said associate professor Gabriel Liu, head and senior consultant at the University Spine Centre at the National University Hospital.

Associate professor Kevin Lim, chairman at the division of surgery and senior consultant of the department of orthopaedic surgery at KK Women’s and Children’s Hospital, added: “This is due to the genetics of scoliosis. Our current understanding is that there is no one ‘scoliosis gene’, but that several genetic factors interact with the patient’s environmental factors to create spinal deformity.”

Most scoliosis patients will not experience any problems or physical pain but, as Dr Reuben Soh, a consultant at the department of orthopaedic surgery at Singapore General Hospital, noted: “In some severe cases, the patient might experience some back pain, asymmetrical rib prominence, unequal shoulders or unequal waist, which is largely cosmetic in nature.” Unfortunately, scoliosis is incurable.

All doctors can do is prevent its progression in severity.

“In general, mild scoliosis, which is below a 25-degree curvature, only requires observation. Moderate scoliosis, between 25 to 40 degrees, may require spinal bracing to reduce the likelihood that the condition will progress to the stage where surgery is required,” said Prof Lim. “Surgical intervention is often the viable treatment option for patients with severe scoliosis, above 40 degrees, whose skeletal systems have already matured.”

Prof Liu added: “The most common surgical treatment for scoliosis is spinal fusion using titanium screws, hooks, rods and bone graft to carefully straighten the curve through incision along the back of the spine.”

Screening programmes are conducted in primary and secondary schools to pick up scoliosis at an early age and patients are seen at the Health Promotion Board.

“This remains a useful way of raising awareness of the diagnosis both to the child as well as to the parents, such that early intervention in the form of bracing can be undertaken should the child fit the criteria of bracing,” said Dr Soh.

However, adjunct assistant professor Loo Wee Lim, consultant of orthopaedic surgery at Changi General Hospital , noted: “More education and research can still be done to inform the public of this condition.”

While scoliosis is incurable, patients are urged to pursue a normal life. “From the clinical standpoint, we encourage patients to have an active lifestyle with recruitment of the core muscles to maximise the stability of the spine. Pilates and swimming are examples of such core strengthening muscle programmes available,” said Dr Soh.

As scoliosis usually does not lead to any physical pain, many patients may never realise they have the condition.

“Concerned individuals can approach the polyclinic or general practitioners to perform a forward bending test to screen for any scoliosis. If the test is positive, the individual can get a standing X-ray at the polyclinic,” he added.

Although “there is no explanation as to the cause of scoliosis”, according to Dr Soh, Prof Lim suggests that “parents of children with a family history of scoliosis should be even more vigilant”.