Scoliosis is a medical term which literally means a deformed or crooked spine towards one side. This technically means a lateral curvature of the spinal column. Truly speaking, this is a three-dimensional deformity with the vertebral column tilting to one side, bending either forwards or backwards, and rotating towards one side.
What causes Scoliosis?
This condition is present in two broad age groups: one less than 18 years and the other above 60 years.
1. Adolescent Idiopathic Scoliosis
The most common variety is found in the adolescent age (10-18), more commonly in girls, where the reason for the deformed spine is not known. This is labeled as Idiopathic Scoliosis.
This kind of scoliosis can also be found in early age groups:
- Infantile Idiopathic Scoliosis: Detected within the first three years of life.
- Juvenile Idiopathic Scoliosis: Detected between 3-10 years of age.
These are less common than the adolescent variety.
Other Causes Include:
- Congenital Scoliosis: Where one side of the vertebral column is either not fully formed or fully separated, leading to differential growth.
- Neuromuscular Causes: Due to muscle weakness as seen in Cerebral Palsy or Poliomyelitis.
- Degenerative Scoliosis: In old age, due to differential degeneration of the disc or facet joints.
Since the cause-based division did not always impact treatment, scoliosis was further divided into Early Onset (before 5 years) and Late Onset (after 5 years). This distinction is crucial because lung development occurs in the first 5 years of life; traditional spine surgery at this age could be catastrophic for breathing.
Symptoms & Diagnosis
The biggest problem with scoliosis in our society is late diagnosis. Because it’s a slow change in body shape, it often takes 2-3 years before parents or the child notice a problem. Even when noticed, it is sometimes falsely dismissed as a cosmetic issue.
Look for:
- Shoulders at different levels
- Asymmetry in the back, chest, or pelvis
- One shoulder blade sticking out more than the other
Since this is often a cosmetic problem initially, it is usually missed as the child plays around with no functional disability.
Treatment Options
The treatment is simple once identified. Full-length spine X-rays help predict how fast the deformity will progress as the child grows. This determines whether we use observation, bracing, or surgery.
Surgical Approaches:
- Fixation & Fusion: A definitive surgery typically done after 5 years of age. It involves fixing and fusing the involved levels of the spine.
- Growth-Friendly Surgery (Non-Fusion): For younger children, we do a limited fixation without fusing the spine. This allows the chest and lungs to continue growing while controlling the deformity. A definitive surgery is done later at an adequate age.
All surgeries are performed with the assistance of Neuromonitoring, which helps control the amount of correction without damaging the nerves or leg power.
Take Home Message
Identify the problem early so it can be managed with minimal intervention. Even if surgery is required, early intervention yields significantly better long-term results compared to delayed treatment.