​British royalty puts the spotlight on a common disorder which usually occurs in childhood.

When Britain’s Princess Eugenie walked down the aisle in a gown that showed off a long scar on her back, she put scoliosis in the global spotlight.

She had developed the condition in her childhood, and had surgery to straighten her spine at 12. Showing off the scar at her wedding was a way of getting to terms with the trauma and pain that she felt at the time, she said. It was also a way of helping to take away the stigma of the disease that other young sufferers might feel.

A condition that can strike at any age, scoliosis, or a sideways curve of the spine, tends to occur more commonly among children and adolescents, particularly girls. It generally does not cause problems, especially if the condition is mild and treated early. If severe or left untreated, however, the disorder can lead to problems in later life, such as nerve compression, pain in the back and legs, and even breathing difficulties as the disorder leads to pressure on the lungs.

A school screening programme that started in 1982 picks out boys and girls with spine curvature from Primary 5 and sends them for follow-up if the angle of curvature is greater than 10°, said Dr Reuben Soh, Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital (SGH).

The hospital tends to see young scoliosis patients between the ages of 10 and 16, he said. “That’s when they have their pubertal growth spurt. The spine grows the fastest during this time, and it may curve and show up as scoliosis,” he said.

“Six months before they start menstruating and two years after is the time when girls grow the fastest — and when they have the greatest chance of developing scoliosis,” said Dr Soh. It’s harder to determine when boys mature and when they stop growing, so “we tend to see them for a bit longer until they are midway through their National Service”, he added.

The annual programme screens about 95 per cent of Singapore school children.

Brace yourself

It is not clear why the spine curves for some and not for others. Even for twins, one may develop scoliosis, and the other not. In most cases, surgery is unnecessary and treatment involves wearing a brace that applies corrective pressure on the growing spine to prevent the curve from progressing. A brace, which has to be used when the curvature is at least 20°, needs to be worn for 16 hours a day.

If the spine curves more than 45°, surgery is needed. Titanium pedicle screws are put into the affected vertebrae to straighten the spine. “We know that if they don’t wear a brace, the scoliosis will progress. We also know that if the curve is over 45°, it will worsen 1° per year,” said Dr Soh.

Getting children to wear a brace isn’t easy as it can be uncomfortable in Singapore’s warm climate. Children can also feel self-conscious wearing a brace, which is made from fairly stiff plastic moulded to fit the body.

Adults can also get scoliosis, but their condition is more likely to be due to the wear and tear of ageing. Those who had the disorder as children are also likely to suffer from it when they reach their 50s or 60s.

Women, in particular, should maintain their fitness to help boost muscle strength and flexibility to prevent or slow wear and tear of the spine. “Weight-bearing exercises, jogging, swimming, and Pilates are very useful for both men and women,” said Dr Soh.