Scoliosis Management

The spine is designed to appear straight when viewed from the back, allowing the body to remain balanced while standing and moving. It also protects the spinal cord and distributes mechanical forces evenly during daily activities.

Scoliosis is a condition where the spine curves sideways in an abnormal “C” or “S” shape, often accompanied by vertebral rotation. This alters normal spinal alignment and can affect posture, balance and load distribution. While mild curves may cause little disturbance, more significant curvatures can progressively influence biomechanics and overall function.

Scoliosis can develop during adolescence or later in adulthood due to degenerative spinal changes.

What are the types of scoliosis?

Scoliosis is classified based on its underlying origin, which includes:

• Idiopathic scoliosis — the most common type, particularly in adolescents, where no single identifiable cause is found.
• Congenital scoliosis — caused by abnormal vertebral formation during fetal development.
• Neuromuscular scoliosis — associated with neurological or muscular conditions that impair spinal support.
• Degenerative (adult-onset) scoliosis — develops later in life due to disc degeneration, joint arthritis and progressive spinal imbalance.

What causes scoliosis?

The condition develops through structural or biomechanical imbalance within the spine. That can include:

• Asymmetric vertebral growth — uneven growth rates on one side of the spine can cause progressive curvature, particularly during adolescent growth spurts.
• Rotational spinal instability — abnormal vertebral rotation alters load distribution, reinforcing curve progression over time.
• Congenital vertebral malformation — incomplete segmentation or formation of vertebrae leads to structural asymmetry from birth.
• Neuromuscular imbalance — impaired muscle control or weakness reduces the spine’s ability to maintain neutral alignment.
• Degenerative disc and joint collapse — age-related disc height loss on one side of the spine can cause gradual lateral curvature in adults.

What are the symptoms of scoliosis?

Symptoms vary depending on age and curve severity, but may include:

• Back fatigue – a feeling of tiredness or heaviness in the back muscles, especially after prolonged standing or sitting
• Uneven shoulders — one shoulder may appear higher than the other due to the sideways curvature of the spine, altering overall alignment
• Rib hump — when bending forward, one side of the rib cage may appear more prominent
• Pain — when present, it may feel like localised back discomfort or stiffness, more commonly seen in adults due to degenerative changes
• Clothes fitting unevenly — shirts, dresses or waistbands may sit unevenly or appear twisted, as this often reflects a subtle postural imbalance caused by spinal curvature

How is scoliosis diagnosed in Singapore?

Diagnosing scoliosis involves a structured evaluation that is designed to assess its severity and develop a personalised management plan. A thorough assessment ensures that the chosen treatment is appropriate for the type, location and progression of the spinal curve.

Clinical history

This initial step helps Dr James Tan understand how scoliosis affects you and how it has developed over time. The focus includes:

• Growth stage, age at onset and curve progression — identifying when the curve first appeared and whether it has been changing helps predict future progression.
• Activity level and functional limitations — understanding daily activities, sports or work demands provides insight into how scoliosis impacts function.
• Pain, discomfort or neurological symptoms — any numbness, tingling or weakness is noted to assess potential nerve involvement.

Physical examination

The next stage evaluates posture, spinal alignment and neurological function. Dr James Tan will perform:

• Postural assessment — observing shoulder, scapula and pelvic symmetry to detect deviations in spinal alignment.
• Adam’s forward bend test — a simple test to visualise spinal curves and identify rotational deformities.
• Neurological evaluation — checking muscle strength, reflexes and sensation to identify any nerve involvement or functional impairment.

Imaging test

Imaging provides objective information about curve magnitude, structural changes and potential nerve compression. Our imaging approach includes:

• X-rays — used to measure the Cobb angle and confirm the location and severity of spinal curves.
• Magnetic Resonance Imaging (MRI) — provides detailed visualisation of soft tissue, discs and any nerve involvement.
• Computed Tomography (CT) scans — reserved for complex or atypical cases requiring precise bone or structural assessment.

What are the stages of scoliosis?

The severity of the condition is measured using the Cobb angle, which guides monitoring and treatment planning:

• Mild (10 – 20°) — usually monitored with periodic imaging.
• Moderate (20 – 40°) — may require closer follow-up or bracing in adolescents.
• Severe (>40 – 50°) — higher likelihood of progression and may require surgical consideration.

Staging is crucial as it helps determine whether observation, bracing or surgical correction is appropriate.

How is scoliosis managed in Singapore?

Management of scoliosis is tailored to the patient’s age, curve severity, growth stage and functional limitations. Dr James Tan develops personalised plans to maintain spinal health, prevent progression and support quality of life.

Observation and monitoring

• Regular check-ups — for children with small curves (<20 degrees), routine follow-ups every 4 to 6 months are recommended. X-rays are used to track curve progression over time. This approach ensures that any worsening is detected early, allowing timely intervention before the curve becomes more severe.

Bracing (adolescents)

• Curve management during growth — braces are recommended for growing children with moderate curves (20 to 45 degrees). While they do not correct existing curves, braces help prevent further progression. Compliance with wearing schedules and proper fit is crucial to achieving the best results.

Casting (babies and toddlers)

• Guiding spinal growth — in children under age two, serial casting is used to gently shape the spine as the child grows. Casts are changed periodically to accommodate growth and gradually correct curvature, helping avoid early surgery.

Physical therapy and exercise

• Strengthening and posture — physiotherapeutic scoliosis-specific exercises (PSSE) improve muscle balance, spinal alignment and posture. Low-impact activities such as swimming, yoga or Pilates support spinal health, enhance core stability and may help reduce discomfort.

Pain management (adults)

• Symptom control and lifestyle support — for adults with scoliosis, pain can be managed with non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and lifestyle adjustments such as weight management and posture training. These measures reduce stress on the spine and improve daily function.

When is surgery recommended in managing scoliosis?

Surgery is typically considered for severe or progressive curves when conservative measures are insufficient. Surgical approaches aim to correct alignment, stabilise the spine and prevent long-term complications such as pain or cardiopulmonary compromise.

However, it is often the last resort for managing scoliosis. This is due to its invasive nature and potential complications. As such, surgery is only considered when:

• The spinal curve is severe (usually >50 degrees) and continues to progress.
• Conservative measures such as bracing or physiotherapy fail to halt curve progression.
• The patient experiences significant pain, functional limitations or neurological symptoms.
• There is a risk of long-term complications, including impaired lung or heart function due to thoracic deformity.

What happens if scoliosis is left unmanaged?

If significant scoliosis progresses without monitoring or intervention, potential complications may include:

• Progressive spinal deformity
• Chronic back pain
• Reduced spinal mobility
• Early degenerative changes
• Rib cage restriction affecting lung capacity (in severe thoracic curves)
• Psychological impact due to visible asymmetry

Book an Appointment

If you have noticed uneven shoulders, postural imbalance or persistent back fatigue or if your child has been flagged during school screening, an early assessment can provide clarity and reassurance.

A consultation with Dr James Tan allows for a structured evaluation, a clear explanation of curve severity and personalised guidance on whether monitoring, physiotherapy or further intervention is needed.

Book an appointment today to take proactive steps to protect your long-term spinal health.