Most of us don’t spend much time thinking about our spine. Maybe you remember those school checks where everyone bent forward while a teacher or nurse looked for uneven shoulders. For many, that was the only time scoliosis was ever mentioned. Years later, it often comes back into focus in smaller ways: a child’s school uniform hanging unevenly, a tilt noticed in family photos, or back pain that lingers no matter how much you stretch or rest.
These moments can be easy to brush aside. But sometimes they’re the first signs of scoliosis, an abnormal curve in the spine that changes the body’s frame, not just the way we sit or stand. Spotting it early often means more ways to manage it and fewer long-term problems.
Scoliosis doesn't present the same way across ages, noted Dr Tan, orthopaedic surgeon. It's classified by the age at which it develops: infantile (0–3 years), juvenile (4–9 years), adolescent (10–18 years, the most common), and adult, which typically develops after 18 years as degenerative scoliosis.
The underlying causes are varied. Some stem from congenital bony abnormalities such as hemivertebra or failure of vertebral segmentation. Others are linked to neuromuscular conditions including cerebral palsy, polio, or spinal muscular atrophy, as well as connective tissue syndromes like Marfan and Ehlers-Danlos. Still, the majority of cases are idiopathic, meaning the exact cause remains unknown.
Progression also differs. Curves related to congenital deformities or neuromuscular conditions can advance rapidly, whereas idiopathic and degenerative scoliosis usually progress more slowly. In adolescents, however, a growth spurt often accelerates the curve progression significantly.
A different story for kids and adults
For children and teenagers, scoliosis often develops during growth spurts. A small curve at 10 can become a large one by 15 if it’s not monitored. That’s why school screenings and regular check-ups are important. At this stage, early action such as wearing a brace can guide growth and reduce the chance of needing surgery later.
In adults, scoliosis plays out differently. Some carry curves from childhood that only start causing problems later. Others develop it as the spine naturally wears down with age. In both cases, the strain shows up in daily life: back pain after simple tasks, difficulty carrying groceries, or discomfort after sitting or standing for long periods. Muscles work overtime to support the uneven spine, leaving some people fatigued.
Early detection plays a pivotal role in altering the long-term impact of scoliosis, as it allows preventive steps to be taken before the spinal curve progresses. In Singapore, screening programmes target students during their growth spurts: girls from Primary 5 to Secondary 2, and boys from Secondary 2 to Secondary 4.
Screening is typically carried out using the Adam’s Forward Bending Test, which helps to identify trunk rotation. A scoliometer is used to measure the angle, and a reading of more than 5 degrees usually leads to referral to a spine surgeon for full spine X-rays and an assessment of the Cobb angle.
Outside of formal screenings, there are other signs that are often overlooked. Uneven shoulders, asymmetrical hips, or an apparent difference in leg length can all be subtle indicators of scoliosis in both children and adults.
What happens if the condition is untreated
Scoliosis doesn't always move quickly, but leaving it unchecked can affect how you live.
Children risk rapid progression during growth, and adults may still see gradual changes over time.
Uneven strain on muscles and joints often leads to fatigue and long-term discomfort.
Severe curves can press on the chest and limit lung capacity.
Teenagers may feel self-conscious about appearance, and adults may avoid activities they once enjoyed.
Non-surgical interventions can be effective, but only when applied early and with strong patient commitment, explained Dr Tan. If the curve reaches 20 degrees or more before a growth spurt, a spinal brace is often prescribed to arrest progression. The most commonly used is the Boston brace, which stabilises the thoracolumbar region. Alternatives include the Chêneau brace or the flexible SpineCor brace.
Both the Boston and Chêneau braces are rigid and customised to the patient. They must be replaced after about 5 cm of growth or when they no longer fit properly, and crucially, they need to be worn for 23 hours a day to be most effective.
Another option is Schroth Therapy, a specialised physiotherapy programme that uses targeted exercises. For meaningful results, patients must commit to 30 to 60 minutes of daily practice to stop or even reverse curve progression.
“In summary, while non-surgical options are available, they need to be applied early, and success ultimately depends on the patient’s discipline in wearing the brace consistently and following Schroth exercises every day,” Dr Tan emphasised.
How to describe your symptoms to your doctor
One reason scoliosis is sometimes overlooked is that it's hard to describe. Telling your doctor “my back feels off” doesn't provide enough detail. What helps most is explaining what you see, how it feels, and how it affects you on a daily basis.
These details help your doctor decide whether an X-ray is need to confirm scoliosis.
Surgery becomes necessary when there's documented evidence of curve progression on serial spinal X-rays. The approach depends largely on the patient’s age, the type of curve, and skeletal maturity.
For younger patients with juvenile or neuromuscular scoliosis, surgeons may insert a growing rod to allow continued spinal growth. These rods can be lengthened as the child grows, and newer models can even be adjusted magnetically, avoiding repeated trips to the operating theatre. In certain cases, a vertical expandable prosthetic titanium rib (VEPTR) is used to expand the rib cage and provide additional support.
Among adolescents still in their growth spurt, a minimally invasive procedure known as Vertebral Body Tethering (VBT) may be used. This technique aims to control the curve without fusion, capitalising on the patient’s remaining growth before skeletal maturity.
For skeletally mature patients, surgery usually involves a posterior approach to correct the curve and fuse the spine. Advances in material sciences have enabled the use of stiffer cobalt-chrome rods and innovative “railroad” rod systems, which allow powerful correction without the need for an anterior release.
Equally significant are recent technological advancements. Spine navigation and robotic-assisted surgery have made scoliosis procedures safer, more precise, and more effective in preserving mobility.
Living with scoliosis
A diagnosis doesn't mean giving up sports, dance, or the activities you enjoy. Many people with scoliosis live active, fulfilling lives. The key is consistency: following exercises or therapy, pacing activities, and keeping regular check-ins with your doctor.
For children, that may mean bracing or close monitoring during growth. For adults, it could mean physiotherapy, strengthening the core, or adjusting routines to manage pain.
Scoliosis may change how you move, but many people continue living active, fulfilling lives.
The impact of scoliosis on physical function and quality of life depends largely on the severity of the curve, explained Dr Tan. For curves under 40 degrees, the effect is usually minimal. But more severe curves can alter posture, leading to back pain and functional limitations that often worsen with age as muscles weaken.
In very severe cases, where curves exceed 80 degrees, respiratory function may also be compromised. Severe kyphosis, or forward bending of the spine, can cause significant pain because of the difficulty in standing upright.
In addition to the physical challenges, scoliosis can also take a psychological toll. Body image and self-esteem issues are particularly pronounced in adolescents, when clothes may not fit well and peer acceptance is so important.
That's why early diagnosis matters. Identifying scoliosis in its early stages makes it possible to begin non-invasive interventions with the goal of avoiding surgery. And if surgery does become necessary, discussing it early can help families prepare mentally, emotionally, and financially.
Why noticing small changes matters
Scoliosis often goes unnoticed because it doesn't hurt at first. But early recognition makes treatment easier and outcomes better. The first clues often come from small details:
- A parent spotting uneven shoulders in their child
- An adult realising persistent back pain doesn't match their age or activity level
- A friend pointing out a tilt in a photo
These small observations can be the start of a conversation that leads to answers and early treatment.
If something looks or feels off, whether it’s a tilt, a twist, or an ache that doesn't add up, speak to your healthcare provider. The curve may be subtle, but its impact on your health and comfort isn't.
Dr Gamaliel Tan
Senior Consultant, Orthopaedic Surgeon
Ortho Spineworks / Ortho Associates, Singapore
Instagram: @orthospineworks
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