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Scoliosis is a medical condition characterized by an abnormal sideways curvature of the backbone or spine. Unlike normal spine, which is positioned centrally and runs straight down the back, scoliosis affected spine is either curved towards left or right, it may be in the shape of S or C. It most often happens during the growth spurt just preceding puberty, typically between the age of 10 to 15 yrs.
Boys and girls are almost equally affected with mild idiopathic scoliosis. However, in girls the condition tends to worsen over time as compared to that in boys. Therefore, in girls, scoliosis calls for treatment invariably.
Scoliosis may be mild or severe. The curvature may vary in intensity, however, if the angle of curvature exceeds 10 degree, it is referred to as scoliosis.
Most of the cases of scoliosis are mild. However, in some cases, the condition may worsen over time.
Severe scoliosis impedes the normal functioning of the lungs due to decreased space in the chest cavity. The course of treatment is determined by the intensity of the defect and also, its stability or worsening over time. Mild cases just need continuous monitoring done through X rays to check if it is worsening. Generally, most such cases do not call for treatment. Back brace may be recommended at times, in order to check its worsening. Severe defects may need spine correction surgery.
Scoliosis that got diagnosed in adolescence tend to continue in adulthood.
Q1 What are the symptoms or signs of Scoliosis?
A1 Scoliosis may present as
Uneven level of shoulders
One hip higher than the other
Prominent shoulder blade on one side in contrast to the other
You do not actually focus on everyone's spine to notice any deviation. You tend to notice it when there is any deviation in the way one stands i.e., the person with scoliosis tends to lean towards one side, has uneven hips or shoulders.
Q2.What are the causes of Scoliosis?
A2 Generally, the cause is unknown. In medical parlance, it is termed as Idiopathic Scoliosis, which means without any known cause. Heredity also play a role as it tends to run in families. So, it is importnat to screen those children regularly for the presence of scoliosis who have a family member with scoliosis.
In lesser number of cases, the cause is evident. These causes may be:
Injury or infection of the spine
Birth defect caused due to faulty development of the spine
Neuromuscular pathological conditions such as Cerebral Palsy or Muscular Dystrophy
Genetic conditions such as Marfan's syndrome or Down syndrome
The scoliosis curve with a known cause is classified into two types structural or non structural. In non structural scoliosis curve the function of the spine is not compromised, however, there is a sideways curve. Usually, these types of scoliosis cases happen if there is inequality in leg length, muscle spasm or an inflammation such as Appendicitis. This type of scoliosis condition is temporary and tends to fade away once the cause is treated.
One the other hand, in structural scoliosis, the curvature persists.
Q3 What are the complications of scoliosis?
A3 Severe Scoliosis may interfere with the normal functioing of the heart and lungs, chronic back ache and appearance issues.
Q4 What are the different types of Scoliosis?
A4 Scoliosis may be classified as
Primary or Idiopathic: It does not have any known cause.
Secondary Scoliosis: It has a known cause.
Primary scoliosis may be further classified depending upon the age at which it occurs:
Infantile: Here, the scoliosis occur in the first three years of life. Males are affected more. Left side curvature (Levoscoliosis;Levo-left) is more common than right side curvature (Dextroscoliosis;Dextro-Right).
Juvenile: Age of occurrence is from 4 to 10 years; females are more affected and right side spine curvature is more common than left side spine curvature.
Adolescent: Age of occurrence is from 10 to 18 years; females are more affected and right side spine curvature is more common than left side spine curvature.
Secondary Scoliosis is further classified on the basis of its cause which may be:
Congenital or present right from the birth
Idiopathic Scoliosis constitutes 80 % of the scoliosis cases. This type is the most common type of scoliosis. Next in prevalence comes the Congenital type which may be due to structural defects of the bone or neural tissues and constitute 10 % of the scoliosis cases. Neuromuscular, developmental and tumor related scoliosis types form the remaining 10%.
Q5 Does scoliosis happen in adults also?
A5 Scoliosis affecting teens may continue in adulthood as well. Also, degenerative scoliosis occur in adults due to degenerative or deteriorating changes in the spine, in vertebrae and intervertebral disc precisely, with growing age.
Q6 What is the treatment for scoliosis?
A6 The spine specialist takes into account the following factors in order to device the best ttreatment plan to treat your or your child's scoliosis.
Intensity of curve
Type of scoliosis
Symptoms present such as pain, restriction in function, appearance and breathing difficulty
Scope of growth of your spine in case of kids
Once diagnosed and evaluated in terms of the above factors, then the treatment may be:
Spine correction or scoliosis surgery
Q7 What is scoliosis surgery?
A7 Scoliosis correction surgery can be classified into the following two types:
Scoliosis Spine fusion surgery is characterized by the fusion or joining of small vertebras together and immobilize their independent movement. Small fragments of bones or bone like material are placed in between vertebra, metal rods, screws or wires are used that keep the vertebras straight and still, until the new and old bone fuse together.
Now the question arises as to what does the surgeon want to achieve through the fusion surgery. The goal is to align the curved spinal coloumn bones correctly and fuse them for good into one solid bone.
Q8 When is back brace for scoliosis required?
A8 In a child of growing age, back brace is often recommended to take care of moderate intensity of scoliosis. Although, it does not correct the spinal curvature, but it may prevent further worsening of the scoliosis. It is worn day and night. They are usually made up of plastic. One may stop wearing back brace if the bones have stopped growing, which may be under the following conditions:
When there is no change in the height of the child
Around almost 2 yrs after the girls have started mentruating
When boys require to shave daily
A child may participate in sports activities or any physical activity with minimal restrictions, if need be. The child can take off the brace, if desire. However, the more number of hours the child wears it, the more feective it is going to be in taking care of the scoliosis and preventing its worsening. It is not visible outside as it is worn under the clothes and is shaped to conform to the body. It fits snuggly under the arms, around the ribs, lower back and hips.
Q9 Do I really need surgery? I am skeptical.
A9 Curves that exceed beyond 45 to 50 degree call for surgery even if the affected person is grown up. Such curves tend to worsen over time and cause severe compromise in the lung function and appearance.
However, if the curve intensity lies between 40 to 50 degrees in a growing child, please consult your spine surgeon as there are several factors that will influence his decision of whther to carry out the scoliosis correction surgery or not.
Q10 How successful is the scoliosis correction surgery?
A10 Spinal curvature can be stopped from getting worse with the help of the spine fusion surgery and even the curvature can be straightened to a great extent with the use of high end technology, thereby improving the appearance of the spine.
Q11 I have heard about this term"Cobb's angle" during my doctor's visit. What is meant by Cobb's angle?
A11 Technically, the intensity of the spinal curvature is measured in degrees and this is referred to as Cobb's angle. It is named so after the name of the American Orthopedic surgeon who originally used it. The goal of measuring the degree of the spine curvature is to be able to devise a suitable treatment plan for the patient accordingly.
The curvature(Cobb's angle) that equals 10 degree confirms the diagnosis of "Scoliosis" in the person. It is the minimum anglulation required to actually call it a scoliosis.
Dr Nipun Bajaj
MBBS, DNB(Orthopedic Surgery),FNB(Spine Surgery)
Dr Bipin Swarn Walia
MBBS,MS(General Surgery), M.Ch(Neurosurgery)
Director – Neurosurgery & Head - Unit 1 & Neuro Spine Program
Max Super Speciality Hospital, Saket, Delhi
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Mr Kwasi (Ghana)
08 Jan , 2017
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