Scoliosis

Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people develop abnormalsideways curvature in the spine that is called as scoliosis (Hindi – kubb). The sideways bend results in the ribs becoming prominent on one side. This prominence is referred to as ribhump or razorback (hindi – kubb). This ribhump is perceived as a deformity by the patient and their parents and if it is severe it can result in a deformity that is obvious even when covered with clothes.

Patients with scoliosis may notice one shoulder to be higher than the other. They may have a shoulder blade prominent, asymmetrical breasts, asymmetrical waistlines and a tilted pelvis with one hip more prominent that the other.

On an x-ray, the spine of a person with scoliosis looks more like an S or a C than a straight line. On X-rays, the severity of scoliosis curve is measured by an angle called Cobb angle. When Cobb angle is more than 50 degrees, scoliosis almost always needs surgery. Curves less than 30 degrees usually do not need surgery. Braces like Milwaukee brace and Boston brace may be used for curves between 20 and 50 degrees. Curves more than 80 degrees can compromise the functioning of heart and lungs and should always be corrected with surgery.

Scoliosis does not come from carrying heavy things, athletic involvement, sleeping/standing postures, or minor lower limb length inequality. Patients with scoliosis should do lots of stretching exercises as in hanging from an overhead monkey bar. Swimming and some yoga asanas (like Bhujangasana) are also beneficial.

Corrective surgery for scoliosis is usually performed from the middle of the back. The curvature in the spine is corrected using titanium screws and rods and the bones involved in the curvature are then fused together so that the curve does not progress any further with growth.

Scoliosis could be of many types:

  1. Adolescent Idiopathic Scoliosis – The most common type of scoliosis is Idiopathic scoliosis (called so because there is no apparent causative factor). This is most common in teenage girls. The rapid increase in deformity coincides with their pubertal growth spurt. These girls generally seek medical attention because of their deformity. If the curve is expected to reach more that 50 by the time they finish their growth, then corrective surgery will be required.
  2. Neuromuscular Scoliosis – Neuromuscular scoliosis is the next most common type of scoliosis, which occurs in individuals with neuromuscular disorders like Cerebral Palsy, Polio, traumatic paraplegia, muscular dystrophies, etc. Severe C shaped curves with a significant pelvic tilt characterizes this type of scoliosis. Scoliosis results in difficulty with sitting in a wheel chair, impingement of ribs on hips, pressure sores and difficulty in nursing care. Mild curves can be managed with a brace, but moderate and severe curves usually need corrective surgery.
  3. Congenital Scoliosis – Some kids may be born with an anomaly in their spinal bones such that there is progressive bend in the spine with the growth of the kid. Such cases may be associated with Spinal Cord Malformations and always need an MRI Whole Spine to look at spinal cord anomalies. If the curve is progressive, then they almost always need surgery. New techniques like Growth Rod and VEPTR have allowed us to control the curve, while allowing growth of the child so that the child does not end up with a short truck from a spinal fusion very early in life.
  4. Syndromic Scoliosis – Syndromes like Neurofibramatosis, Marfan’s, OsteogenesisImperfecta, etc may be associated with scoliosis. The management of scoliosis in these conditions needs a few factors to be considered with respect to the underlying condition.