SGH and NNI study gets ahead of the curve to straighten out answer to scoliosis

Singapore, 9 April 2024 – Heavy school bags, poor posture, one-handed sports are often blamed for the development of curved spine in teens. Known as adolescent idiopathic scoliosis (AIS), it affects those aged 10 to 19 but has no known cause. A team from Singapore General Hospital (SGH) and National Neuroscience Institute (NNI) has now discovered that the answer to this condition may lie in the brain.

Employing a high-resolution and quality diffusion tensor imaging (DTI) brain MRI technique for brainstem tractography, the team found that patients with AIS had side-to-side differences in the corticoreticular pathway when compared against participants without AIS. This pathway links the brain’s cortical motor areas and spinal cord and plays an important role in controlling one’s posture and balance.

Associate Professor Reuben Soh, Senior Consultant, Department of Orthopaedic Surgery, SGH, and the study’s first coauthor, shares, “We see patients as young as 10 years old and oftentimes, parents have the misconception that it's bad habits or lifestyle factors that are the cause of scoliosis. We embarked on this study to try uncovering the real reason and in doing so, we hope to be able to better care for patients and support them and their families in managing the condition.”

In the study of 34 participants completed in 2020, brain scans of those with AIS showed that the corticoreticular pathways connected to the right and left sides of the brainstem had asymmetric quantitative measurements. Their scans also showed an enlargement or swelling of pons in the brainstem, the bottom part of the brain linked to the spinal cord. In those without AIS, the pathways showed symmetric quantitative measurements, and the pons was not enlarged.

Professor Lo Yew Long, Senior Consultant, Department of Neurology, NNI@SGH, and senior author of the study, says, “This discovery suggests that scoliosis is fundamentally related to our brain and spinal cord. It could bring about changes in the way AIS is diagnosed or treated. For example, neurological interventions may potentially be employed to prevent worsening of spine curvature. This could include the use of magnetic fields or low electrical currents to stimulate or modulate brain activity.”

Symptoms of AIS include abnormal spine curvature, uneven shoulders, hips, and waist. The condition affects about 3 per cent of all adolescents in Singapore, with majority being female. SGH’s scoliosis clinic sees about 300 cases each year. About 5 to 10 per cent of patients have AIS severe enough that will require complex spine surgery, as it can cause nerve damage or breathing problems.

There is no cure, but in most cases, where the spine curvature is not severe and not at further risk of progression, patients are able to manage their condition with physiotherapy. The scoliosis clinic has a team of specially-trained physiotherapists to help these patients achieve improved mobility and muscular symmetry through exercise and core strengthening, which in turn helps to reduce the degree of spine curvature.

The study’s corresponding author, Professor Chan Ling Ling, Senior Consultant, Department of Diagnostic Radiology and the newly formed Department of Neuroradiology, SGH, adds, “Looking ahead, we hope to conduct further studies on a larger cohort incorporating genomics, and using more advanced diffusion MRI modelling. This may enable us to potentially identify those at risk of developing AIS or AIS progression, or even understand why females are at higher risk of developing this condition.”

The paper was published in Clinical Radiology in February 2024.

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For media enquiries, please contact:

Candice Lee
Communications Department
Singapore General Hospital
Mobile: 9146 3107
Email: Candice.lee.l.f@sgh.com.sg

Margaret Perry
Corporate Communications
National Neuroscience Institute
Tel: 9457 8726
Email: Margaret_Ellen_Perry@nni.com.sg

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About the Department of Neuroradiology

Established in August 2023, the SGH Department of Neuroradiology provides subspecialised neuroimaging and neurointerventional service to support clinical care for our patients in the SGH Campus as well as other public and private institution referrals.

The Department delivers timely, accurate and holistic diagnostic and interventional services in brain, spine and head and neck radiology, ranging from routine brain and spine MRI and CTs to highly specialised techniques such as MRI Perfusion, MR Spectroscopy, MR Tractography, MRI endolymphatic hydrops and dual energy CT imaging.

About Singapore General Hospital (SGH)

Singapore General Hospital, established in 1821, is the largest tertiary hospital in Singapore and ranked among the world’s best. It provides the most comprehensive patient-centred care with over 50 clinical specialties on its campus. As an Academic Medical Centre, it takes pride in training healthcare professionals and conducting cutting edge research to meet evolving needs of the nation as well as the region. Driven by a strong sense of purpose, SGH is committed to give of its best to heal and bring hope, as it has for over 200 years.

For more information, please visit www.sgh.com.sg

About National Neuroscience Institute (NNI)

The National Neuroscience Institute (NNI) is the national specialist and regional centre for conditions of the brain, spine, nerve and muscles, including stroke, dementia, Parkinson’s disease, brain tumour and brain injuries. Committed to improving patients’ lives, NNI aims to shape neuroscience for a better tomorrow through innovation, research and education.

NNI operates out of 6 hospitals in Singapore – Changi General Hospital (CGH), KK Women’s and Children’s Hospital (KKH), Khoo Teck Puat Hospital (KTPH), Sengkang General Hospital (SKH), Singapore General Hospital (SGH) and Tan Tock Seng Hospital (TTSH).

NNI is a member of the Singapore Health Services (SingHealth) – a public healthcare cluster which manages four hospitals, five specialty centres, eight polyclinics and a network of community hospitals – and the SingHealth Duke-NUS Academic Medical Centre.

For more information, visit www.nni.com.sg.