Dr SK Rajan
Attributing to manifold reasons, India is a home to the largest number of cases of spinal deformities. The major causes include accidents, social violence, nutrition deficiency, post-polio complications and congenital problems. While scoliosis is one of the under rated spinal complications in its mild form, yet the society has stigmatized such patients. Every year the month of June is dedicated to raise awareness about the condition and this year 27th June (Last Saturday) is observed International Scoliosis day. Timely detection and treatment can help in treating the condition, creating awareness among the masses is as much important.
What is scoliosis?
Scoliosis is a deformity when the spine becomes abnormally curved sideways. In most of the cases the cause is not known and it develops and seems noticeable around the teen age. A person is said to have scoliosis when the curve measures more than 10 degrees. Severe spinal curve reduces the amount of space within the chest making it difficult for the lungs to functions.
Causes of Scoliosis
- Idiopathic –Most of the time, the exact cause and reasons are unknown, which is known as idiopathic.
- Known cause –when the scoliosis has clear causes. It is categorized into two –
- Non-structural –The spine looks curved but no substantial hindrance in the functioning of the spine. Sometimes when one leg is longer than the other, it becomes a reason for the curve to form.
- Structural –the causes for structural scoliosis includes birth defects, cerebral palsy, infections or muscular dystrophy. In this condition the spinal curve becomes rigid and is difficult to treat.
- Congenital –Sometimes during pregnancy, baby develops incomplete vertebrates that lead to failure of its division leading to curve in the spine. It is merely noticeable during a child's birth and is prominent when the kid is around their teenage.
- Neuromuscular-This is seen in conditions like poliomyelitis, spinal muscular atrophy, cerebral palsy, Down's syndrome, where the deformity is a result of weakness in the muscles supporting the back. As a result of this, the patient collapses whenever they try to sit up.
- Degenerative –This is commonly found in the geriatric population. As we age, the Bone Mineral Density reduces and the disks and joints of the spine wear out leading to formation of a curve in the lower back.
What are the types of Curve?
Most often the curve looks like a C-shaped and when there are two major curves it appears in the shape of S, commonly known as Double major curve.
- Dextro-scoliosis –when the inclination is towards the right side of the spine.
- Right thoracic
- Right thoracolumbar
- Right Lumbar
- Levo-scoliosis –when the inclination is towards the left side of the spine.
- Left thoracic
- Left thoracolumbar
- Left Lumbar
Symptoms of Adult Scoliosis
The primary and usual symptoms of scoliosis include back pain, and depending upon the position of the curve in the spine, other symptoms may vary. For instance, if the curve is major in the lumbar part, the patient will only feel back pain, but if the curve involves the thoracic spine, back pain may be accompanied by breathing difficulties, reduced lung functions and even heart lung functioning may be compromised. Sometimes in mild to moderate cases (when the angle of the curve is small, the condition is misunderstood for osteoarthritic pain.
As a consequences, depending on the position and severity of the condition a person may develop the following physical traits –
- Cosmetic deformity – Pertaining to the cosmetic appeal, many patients with scoliosis may undergo psychological trauma due to repetitive questioning.
- Irregular symmetry – the body may appear with one shoulder or hip higher than the other
- Imbalanced trunk – A person may appear to be vertically tilted from one side.
- Walking difficulties – As the person with scoliosis may have longer legs, they may feel difficulties in walking.
What are the treatment options?
Observation: A patient with very mild curves are kept under observation before opting for the correct treatment module.
Bracing: In mild to moderate curves in children who are of growing age, braces will help.
Surgery
Spinal Fusion surgery (Deformity Correction and fusion):
When the curve is significant and is still progressive, especially close to skeletal maturity, deformity correction and fusion surgery is performed where the bent or curved structure is held using pedicle screws, hooks and wires to keep the spine straight and still. And when this surgery is performed under the guidance of neuromonitoring and navigation, it helps in relating the position of the surgical instrument accurately in the real time thus increasing the accuracy, lessening the operating time. Moreover, it makes the surgical procedure safe without any complications and ensures a quicker recovery.
The author is Head, Spine Surgery, Agrim institute of Neurosciences, Artemis Hospital, Gurugram
