July 7, 2023
Spine injuries are very common among individuals irrespective of their age and can result in chronic pain and other serious complications over a period of time. Fundamentally, spinal problems present differently in children compared to the adults due to the differences in their spine structure and development.
Why Do Spine Issues Present Differently Among Children and Adults?
The child's spine is more flexible with smaller bones, while the adult spine is stiffer with bigger and stronger bones. Children’s spine is in a growing stage and is not fully formed, unlike adults who have fully grown spine with aspects of aging such as degeneration slowing setting in. This distinction is important to understand in order to diagnose and treat spinal conditions in children and the younger generation.
What are the Common Spinal Problems Children Face?
Spinal conditions in children encompass a range of issues, including deformity of the spine, malformations, infections, tumors, and growth-related problems. The deformities of the spine are categorized into two conditions which are called scoliosis and kyphosis. Scoliosis is an abnormal sideways bending of the spine, which can occur at birth, in infancy, or during adolescence. The Causes of scoliosis vary, including congenital factors, ligament disorders, and neuromuscular conditions like cerebral palsy. Kyphosis, on the other hand, involves abnormal forward bending of the spine. These anomalies in the spine can affect abnormal the nerve and lead to pain and difficulty in walking, and in severe cases the patient may be wheelchair-bound or bedridden state.
Spinal malformations can occur in newborns and can often be diagnosed through ultrasound during the prenatal period. Conditions like myelomeningocele and diastematomyelia can occur during fetal development when the child is born with incomplete formation of the spine. Infections and tumours can also cause spinal problems in children, with specific conditions like tuberculosis (TB) or lung-related infections spreading to the spine. Growth-related problems and small cracks can also arise due to mismatched growth in the spine. So, there are a host of problems that are unique to children and which may not be found in adults.
Fortunately, a lot of spine problems can be identified when the mother undergoes an ultrasound in the ante-natal period where the spinal development can be assessed by a doctor. MRI, CT scan, and other investigations like X-rays can further help in diagnosing spinal deformities after birth.
What is the Best Approach to Treat Spine Issues Among Children?
When it comes to treating spinal conditions in children and young teens, various approaches should be taken into consideration: Medications, surgery, braces, and other non-surgical interventions can be recommended based on the specific condition.
For scoliosis, early detection is crucial for effective treatment. In some countries, school screening programs help identify scoliosis in children, enabling early intervention. Treatment options for scoliosis depend on the degree (angle) of the curve of the spine, where surgical intervention is advised for curves over 40 degrees. Custom-made braces may be used for curves ranging from 10 to 40 degrees, while smaller curves may not require any specific treatment.
Slipped Disc is Another Common Phenomena Among Young Adults. Why Does It Occur & How to Treat It?
Slipped disc is more common in adults due to degeneration, but can also be seen in younger people and even children as young as 12 years old may be due to genetic or micro-trauma. This degeneration leads to sliping out of the disc and result and presses on the nerves, causing pain. Most cases of degenerated slipped discs in younger patients can be managed without surgery. Rest, limited activities, medication (anti-inflammatories and nerve modulators), physiotherapy, and steroid injections to the nerves in the spine are often sufficient. However, in rare cases, surgery (endoscopic or keyhole surgery or a microdiscectomy) may be necessary to remove the part of the disc pressing on the nerve. For cervical disc disease in youngsters, fusion surgery is commonly performed. Cervical disc replacement is a novel approach, that involves removing the damaged disc and replacing it with an artificial one, preserving neck movement and reducing the risk of stiffness.
What are the Challenges Pertaining to Diagnosing Spinal Issues among Kids & Teenagers?
Spinal problems can affect children and young adults, requiring specialized diagnosis and treatment approaches. Unfortunately, culturally we are at a disadvantage in India because most of our children wear very traditional, loose clothing, especially girls. They are more homebound which is why it goes unnoticed when a child has an asymmetrical back. Adolescent idiopathic scoliosis, which happens in teenagers, is more common in girls than in boys. Also, the myth that children should not undergo any surgery before they reach maturity is what causes these spinal problems to become life-threatening. We should understand that children are not spared from spinal problems. When a child has a problem, one must consult a spine surgeon and ensure that basic investigations like an x-ray are done and regular follow-up should be considered in case a spinal deformity is identified.
In conclusion, spine surgeries have become safe and there are years of data available for us because of all the great work that has gone into treating spinal conditions through surgeries over the decades. Now, we all able to predict better results through safer interventions. With advances in technology in the world of virtual reality, robotic surgery, minimally invasive surgeries, magnifications, and endoscopes, we are equipped to help treat patients with any and every spinal condition.