Abnormal curvatures if the spine are referred to as scoliosis and kyphosis. In the normal spine, there are normal curves if seen from the sides, but the spine is seen as a straight column from the front. In scoliosis, the spine shows curvatures from the front. In kyphosis, there is abnormal forward bending of the spine.
Scoliosis is a Greek word meaning curvature. Ancient physicians thought poor posture was the primary cause of scoliosis. Today it is clear that scoliosis is either congenital (present at birth) or developmental and may be hereditary. The spine curves to the side in the shape of an “S” or “C”. The curvature is measured in degrees.
Types of scoliosis
Scoliosis is classified according to the affected age groups:
- Infantile scoliosis: from birth to 3 years old
- Juvenile scoliosis: from 3 to 9 years old
- Adolescent scoliosis: from 10 to 18 years old
We can also classify according to the direction of the curve. A spinal curve to the right is called Dextroscoliosis (“dextro” = right). This is the most common type, usually occurring in the thoracic spine.
It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”).
A spinal curve to the left is called Levoscoliosis (“levo” = left). This is quite common in the lumbar spine, but when this rarely occurs in the thoracic spine it indicates a higher probability that the scoliosis may be secondary to a spinal cord tumor.
Scoliosis may also be classified according to location. Thoracic scoliosis is curvature in the middle (thoracic) part of the spine. This is the most common location for spinal curvature. Lumbar scoliosis is curvature in the lower (lumbar) portion of the spine. A curvature that includes vertebrae in both the lower thoracic portion and the upper lumbar portion of the spine is called a Thoracolumbar scoliosis.
Adolescent Idiopathic Scoliosis is yet another condition that starts around the onset of puberty in otherwise healthy boys and girls. It is more common in girls. Physical signs may include uneven shoulders, one hip lower than the other, a rib hump when bent over at the waist and leaning to one side.
The obvious symptom of scoliosis is an abnormal curve of the spine. In some cases, the head may appear off center or one hip or shoulder may seem higher than the opposite side. In severe scoliosis the heart and lungs may dysfunction leading to breathlessness and chest pain. Back pain, rib pain, and abdominal pain are the other symptoms.
Treatment goal is to stabilize the spine to prevent additional curvature. Patients who are pain free may not seek treatment until the deformity is noticed. Unfortunately, that stage may be actually too late to treat the disease. The size of the curve is measured in degrees on an X-ray. The progression of scoliosis is monitored by periodic x-ray studies. There are non surgical options for Scoliosis treatment for minor deformities, but the more severe and progressive ones require surgery.
For curvature of greater magnitude, surgery is needed. The goal of scoliosis surgery is to achieve a well-balanced spine in which the patient’s head, shoulders and trunk are centered correctly over the pelvis. Instrumentation to reduce the magnitude of the deformity and fusion to prevent future curve progression are the steps involved.
Use of staples on the convex side of the curve, to correct and maintain the curve till the patient is skeletally mature, is a recent development in the treatment of Scoliosis. These staples allow differential growth to take place i.e. less growing speed on the stapled side than the concave side thereby correcting the curve as the child grows.
Nitinol is a titanium based alloy. Spinal implants made from Nitinol are also now being used. The C shaped staples are in the shape of ‘C’ when they are manufactured at room temperature. When the staples are cooled to below freezing point the prongs become straight but clamp down into the bone in a ‘C’ shape when the staple returns to body temperature providing secure fixation. These are called Shape Memory Alloy (SMA) staples. As no fusion is done the child grows normally and even the residual deformity tends to improve with growth.
This novel procedure was performed for the first time in India at Apollo Hospitals on a 6-yr old girl, from a small town near Madurai, by the senior spine surgeon Dr. Sajan Hegde and his team.
Back pain normally does not occur with scoliosis but in case there is pain, the symptoms can be lessened with physical therapy, massage, and scoliosis exercises. These are mainly done to strengthen the muscles of the back. Medical treatment is mainly limited to pain relievers. These will not however cure scoliosis and will not be able to correct the abnormal curve.
UPDATED ON 19/08/2021