Scoliosis is the presence of deformity in the back. It is still one of the underdiagnosed conditions and mostly found in children. Early diagnosis and treatment of this condition have a good prognosis. If neglected in childhood days, it may cause low back pain, early fatigue, or neurological deficit later in life.
What Is Scoliosis?
If we take an X-ray of a person from the front, a normal spine is seen to follow a straight course. But when the spine looks like “S” or “C”, it is called scoliosis. Diagnosis of scoliosis in a young kid causes significant stress in the family both due to fear of progression and the possible complications arising out of surgical treatment, living apart from the financial burden of modern surgical treatment. Many times, scoliosis induces asymmetry in shoulders, trunk or the pelvis which leads to the diagnosis.
What Are the Types of Scoliosis?
Although many causes of scoliosis have been identified, most are due to unidentifiable cause (Idiopathic Scoliosis). Scoliosis due to developmental defect in the vertebral column (Congenital Scoliosis) is usually diagnosed early and progresses. There may be innumerable combinations of developmental anomalies and the progression of the curve is greatly influenced by it. Diseases of the muscles or nerves may also induce scoliosis (Neuromuscular Scoliosis), which usually progresses relentlessly and require early diagnosis and surgical intervention. Rarely scoliosis may be associated with some genetic conditions (Syndromic Scoliosis), diagnosis of which is also paramount for global management of the patient.
Any type of scoliosis may be associated with abnormalities of the spinal cord, heart, kidney and the urinary tract or other systems of the body. So, medical evaluation of scoliosis may involve the evaluation of all systems of the body with the involvement of physicians of other disciplines as well.
How Is It Diagnosed?
Usually, sooner the diagnosis (i.e. younger the kid), more is the chance of progression of the curve. A thorough history regarding the duration of the deformity, progression, achievement of milestones, school performance, spinal deformity in the family, other medical histories, etc., helps to narrow down the diagnosis. This is followed by a detailed clinical examination of the spine and neurological examination.
All scoliosis patients are evaluated by X-ray and MRI with additional evaluation by physicians of different disciplines depending on other systemic or syndromic association. In X-rays, the magnitude of the curve is measured (Cobb angle), which may have few degrees of interobserver variability and is used serially to monitor progression along with clinical evaluation.
How Is It Treated?
It depends on the extent of deformity, type, age of the child, and other associated anomaly. Typically, conditions of the other systems are addressed prior to scoliosis. Smaller curves (20⁰ to 40⁰) in where rapid progression is unlikely, it may be treated with brace although the role of bracing has been validated mainly in idiopathic scoliosis in elder children or teenagers only.
Some congenital scoliosis with potential for rapid progression are treated early or even with prophylactic surgery where delay leading to severe deformity may represent more surgical risk and poorer outcomes.\
Neuromuscular scoliosis and some syndromic types (e.g. NF I) should be treated as soon as possible to prevent relentless progression and to diminish surgical risk and improve outcomes.
Definitive scoliosis surgery is a fusion surgery where the individual vertebrae are fused with one another with screws and rods and bone graft after safe allowable correction of deformity which prevents further progression. Since the growth of the spine on the back of the chest (thoracic spine) allows space for the growth of the lung, premature fusion of the thoracic spine before 8 to 9 years of age prevents full maturation of the lungs due to lack of space and has a significant deleterious effect on the lung function. But unabated deformity of the thoracic spine also compresses on one or rarely both sides of the lung preventing its full development.
In this difficult scenario, a non-fusion spinal surgery is undertaken where spine growth is allowed periodically either with a short duration of spinal surgery (Growing Rods) or from outside with a magnet (Magnetically controlled Growing Rod) to lengthen the construct, thereby allowing thoracic growth (hence lung growth) and correction or maintenance of deformity till patient’s lungs are fully developed and are ready for definitive scoliosis surgery if needed.
Of all the complications of spinal surgery (which is beyond the scope of this information), the neurological deficit is feared by patients, parents and surgeons alike. Some advances in technology help to minimize it, if not fully.
Frequently Asked Questions:
1. Does exercise help or decrease scoliosis?
As in all age groups, exercise will help to strengthen the muscles, but it cannot prevent curve progression and decrease the magnitude of the deformity.
2. Does any alternative medicine help in scoliosis?
Currently, there is no evidence.
3. Is scoliosis genetic?
Yes, some scoliosis are. It depends on the type of scoliosis and its syndromic association.
4. My one kid has scoliosis, is the other at risk?
Although it may not be a strong risk factor, it certainly increases the risk. A close watch should be practiced.
5. Can a scoliosis child lead a normal life?
Yes, a scoliosis child after a successful surgery can lead a normal life. Though there are few restrictions like avoidance of contact sports and also there is reduced flexibility of the spine.
6. When should the surgery be done?
The earlier, the better. Though it cannot be generalized, usually it applies to most of the cases. In early period of detection, the curve is flexible and surgery gives the best results. Moreover, in the early days, a smaller number of vertebral levels needs to be involved. Hence the flexibility of the spine is preserved.
7. Is scoliosis surgery safe?
In spine surgery, scoliosis surgery is one of the extensive surgeries. Safety depends on the magnitude of the curve and the experience of the surgery team. There may be a requirement of multiple staged surgeries in severe magnitude of curve. On the other hand, if the curve is small and flexible, single-stage surgery will do. Nowadays in this advanced era, neuromonitoring is used by all spine surgeons. It helps to analyze the functions of the spinal cord intra-operatively even if the child is unconscious and paralyzed for surgery.
Last reviewed at:
05 Feb 2020 - 4 min read
Query: Hello doctor, For the past two years, I have experienced lower back pain coupled with what I think to be an abnormal inward curvature of my spine. I recently went to a pediatrician and the doctor brushed it off saying there is nothing wrong with my spine. No one believes me even though I have showe... Read Full »
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