February 14, 2022
Abnormal sideward bending of spinal column of the back is called scoliosis. Although it was described initially as sideward bend, it is actually a three-dimensional deformity.
It can be congenital (by birth), idiopathic (cause not known) or neuromuscular (muscle imbalance).
Congenital type occurs as a result of failure of formation of vertebra (e) or failure of segmentation during intrauterine development. There may be a mixed variety too. It is usually associated in consanguinity and there may be additional kidney, heart or spinal cord defects. They are also prone for repeated respiratory tract infections because of reduced lung capacity.
Idiopathic scoliosis occurs at or near the onset of puberty for which no cause has been established until now. A doctor assesses the shoulder level, child’s standing and sitting height at 6 monthly intervals, age of menarche and appearance of secondary sexual characteristics in girls.
Neuropathic type is usually as a sequel of neuromuscular disorders, which can be as a result of involvement of brain/spinal cord or spinal nerve roots.
Scoliosis can be detected early by school screening programmes, by a test known as Adam’s forward bending test. The rib hump becomes prominent when the child is asked to bend forwards. If detected early, attempts can be made to prevent progression of deformity.
The aim of treatment of scoliosis to correct the deformity and prevent progression for 2 reasons:
1. Improve cosmetic appearance
2. Prevention of early degeneration on the concave side and back pain later in life
There are three proven treatments for scoliosis — observation, bracing, and surgery. Doctor will recommend one of these treatments based on the severity of the scoliosis and the physical maturity of the
General guidelines for treatment:
Indications for bracing include curve magnitudes of 20° to 40° by Cobb’s method in growing individuals; if girls, either premenarchal or less-than-1-year postmenarchal status. Stretching exercises are also adjuvants in conservative management.
The surgical treatment of scoliosis is to achieve a long-lasting fusion and to achieve a satisfactory cosmetic correction according to the patient’s perception. Mainly to rebalance the trunk, make the hips symmetric, decrease the rib hump, or all these. The surgery necessitates the usage of implants and bone graft. Postoperatively a brace may be necessary for 3-6 months.
The implants used nowadays are made of titanium. If the child desires, the implant can be removed after 5 years of surgery or after attaining skeletal maturity.
Management of congenital and neuromuscular types is challenging and needs expertise.
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