Scoliosis
Overview
Scoliosis is abnormal side-to-side curvature of the spine. Normally a human spine is straight when seen from back, any deviation to the side by more than 10 degrees is considered scoliosis.
Causes
There are many reasons for abnormal curvature of the spine. Based on the reason behind the abnormal, there are classified.
i. Idiopathic scoliosis -This is the most common variant, in which there is no reason that could be identified.
ii. Congenital scoliosis – This is due to abnormal development of vertebra during early development.
iii. Muscular/ Paralytic scoliosis – This variant is seen in children with muscle weakness like cerebral palsy, muscular dystrophy.
iv. Degenerative scoliosis – This is seen in elderly due to normal wear and tear (degeneration) of spine joints / ligaments and disc.
Symptoms
- Clothes not fitting properly or hanging unevenly
- Curvature of spine observed while in bathing suit or changing
- Changes in walking style
- Reduced range of motion
- Difficulty in breathing
- Cardiovascular problems
- Back pain
- Lower self-esteem
Diagnosis
Since early diagnosis and treatment initiation plays an important role in the disease progression and decision making, consult a doctor on observing any symptoms of scoliosis in your child.
Scoliosis can usually be diagnosed by physical examination. However, your doctor may advise you to get full radiographs of spine to classify what type it is, check curve magnitude, and level of involvement. You may be asked to get further radiographs, to know the correctability or flexibility of the curve by getting side bending/ traction views.
An MRI may be required if you have any neurological symptoms, along with scoliosis. A CT scan may be required to plan for surgery, especially in the presence of bony anomalies like in congenital scoliosis.
Treatment
Most children with mild scoliosis may not require treatment with a brace or surgery, but need regular check-ups to see if there have been changes in the curvature of their spines as they grow.
Before beginning treatment, a few factors are taken into consideration:
- Girls have a higher risk of progression than boys.
- The larger the curve the more likely it is to worsen over time.
- S-shaped curves tend to worsen more than C-shaped curves.
- Curves in the central section of the spine worsen more often than those in the upper or lower sections of the spine.
- If a child's bones have stopped growing, it lowers the risk of curve progression. That's why use of braces is more effective for children whose bones are still growing.
Braces
If your child has moderate scoliosis, your doctor may recommend wearing a brace to prevent further progression of the curve.
The most common type of brace is made of plastic and is contoured to the body so as to fit perfectly under the arms and around the rib cage, lower back and hips, making it practically invisible under the clothes.
Since a brace’s effectiveness increases with the number of hours it is worn, it is advised to have one on 24 hours a day. Braces do not hinder children’s participation in sports or other physical activities, and can even be taken off if, for instance, they want to go swimming.
Once bones stop growing, the braces are discontinued. This typically occurs:
- About two years after girls begin to menstruate
- When boys need to shave daily
- When there are no further changes in height
Surgery
As severe scoliosis progresses with time, your doctor may suggest surgery to reduce the severity of the spinal curve and to prevent it from worsening.
Spinal fusion is the most common type of scoliosis surgery. In this procedure, two or more of the bones in the spine are connected together so that they can’t move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
In case the scoliosis is progressing rapidly in a young patient, doctors can install a length adjustable rod that keeps pace with the child’s growth. The rod, attached to the top and bottom sections of the spinal curvature, is usually lengthened every six months.
