Spinal Deformities

Kyphosis comes from the Greek word ‘kyphos’ which means ‘hump’. So its pretty self-descriptive in that it is the condition where a person has a hunched upper back.

Ordinarily, the thoracic spine (upper back) has a natural forward curvature. This allows the spine to bend and flex, absorbing shock which is transmitted to it. Typical kyphosis for this part of the body is considered 20 to 45 degrees. But when the curvature increases, it is very difficult for the body to effectively carry weight forward causing pain, (possible) progressive deformity and (sometimes) neurological loss of function. Most of the time however, the condition remains fairly constant without becoming progressively worse.

When this condition occurs along with scoliosis it is caused Kyphoscoliosis.

Symptoms

• Poor posture
• A ‘hump’ of the back or ‘hunchback’
• Back pain
• Fatigue
• Stiffness of the back
• Causes

Osteoporosis

• Disk degeneration
• Cancer and cancer treatments
• Scheuermann’s disease: A hereditary disorder which typically affects more boys than girls during the pre-pubescent growth spurt
• Birth defects: On some instances the spinal cord of a baby does not develop properly (within the womb) resulting in kyphosis

Treatment

This is determined by your doctor based on the severity of the condition. Less severe conditions can be treated with exercises which increase flexibility and improve core strength and posture. Children can be treated through the use of a body brace during their growth stages. Sometime injections of various medications are used to relieve pain. In very severe cases where the spinal cord is being pinched the doctor may recommend spinal fusion.

The lumbar spine consists of five vertebrae in the lower part of the spine from the ribs to the pelvis. Lumbar spinal stenosis is a condition where the the spinal canal narrows. Typically the discs become less spongy as you age, resulting in a lowering of disc height and bulging of the hardened disc into the spinal canal. The narrowing of the canal leads to compression of the spinal nerves which are destined for the lower limbs and the urinary bladder. Patients experience pain in the lower limbs on attempting to walk – a condition known as neurogenic claudication.

This is most often a degenerative condition affecting people over the age of sixty although it has been known to affect younger patients due to various developmental causes.

Treatment
Patients who have significant disability due to spinal stenosis will benefit from decompressive surgery with or  without fusion.

Scoliosis is an abnormal curvature of the back along the coronal plane i.e its a deformity of the spine where it curves abnormally sideways. While most kinds are nonfatal, if not detected and treated, scoliosis can progress, affecting the lower back, accelerating wear and tear further down the spine and severely compromise quality of life.

Scoliosis can occur in any age group whether in infancy, adolescence of adulthood and is classified accordingly

Infantile Scoliosis

This affects children under the age of 3 and has a whole range of causes. It could be due to an abnormally developed back bone at birth. It can also develop as a result of other serious congenital or neurodegenerative disorders (cerebral palsy, tethered spinal cord, myelomeningoceles, etc.).

Juvenile or Adolescent Scoliosis

This occurs in the 3 to 10 year age group. Since this coincides with a period of rapid growth in the life of an individual, Juvenile Scoliosis tends to advance rapidly. It may slow down as growth slows. However, given the delicate state of the child’s body, surgery might not be possible at this age.

Adolescent Idiopathic Scoliosis

The most common form of scoliosis occurs in patients in the age group of 10 to 17 years. As the word ‘idiopathic’ implies, there is (thus far) no identifiable cause for it. Adolescent Idiopathic Scoliosis has a broad variety of symptoms and affects patients with varying degrees of severity. It tends to occur in the thoracic spine (above lower back and below the level of the neck) and is not usually painful except in some extreme cases.

Adult Degenerative Scoliosis

This is a form of scoliosis which seems to be on the rise. It occurs in adults with the onset of degenerative arthritis in the lumbar spine. It is not a relapse of any kind since these are patients who never had scoliosis as children. As time progresses, it becomes worse with pain and compression of the nerve(s) from spinal stenosis.

Symptoms

Parents should watch out for warning signs – a little hump on the back or rib, hair along the spine or perhaps a foot problem. A school screening program has been able to detect most of these problems early. Some of the symptoms are:

• Differing (or uneven) shoulder heights
• Head not centred on the axis of the body
• An uneven waistline
• Tilted pelvis
• Difficulty breathing
• Difficulty walking
• Hunchback
• Pain of the back
• Treatment
• Some kinds of scoliosis get worse but most of them (of the Infantile variety) decrease of their own accord within a few years, with or without treatment.

The causes for scoliosis in the childhood and adolescent variety are not known; though research is on to determine the same. Rarely, scoliosis also develops as a result of causes like polio or cerebral palsy. Fortunately, most varieties are nonfatal and cause a deformity of the back which can progress rapidly in the growth phase and slower after maturity.

In most cases, early detection and surgery can solve the problem, and the child’s growth improves. Decisions for treatment are based on the severity of the curvature, and the risk of progression or worsening of the curvature. Surgery is occasionally required, but non-operative techniques are often used to allow for spinal growth prior to a spinal fusion procedure.

For less severe varieties of scoliosis, either observation or bracing during the growth phase should be sufficient.This is in order to let the child grow to an age and physical size more suitable for surgical correction. In severe cases though, surgery is performed before adolescence. Surgery is called ‘fusion’ and basically is the straightening of the curve of the spine using screws and rods inserted into the spinal column. Bone grafts are used to fuse the structure together with the skeletal system. Surgery done in time can halt progress of the condition, reduce the early onset of spondylosis and increase functionality of the back.

Patients are generally out of bed in a day or two after the surgery depending on the pain relief. They are allowed to shower at about 2 weeks of surgery. They are advised to begin schooling back again in about two months of surgery. They are advised not to bend forwards or lift weights till about 6 months after which there are very little limitations. Participation in contact sports is generally withheld in the long run.

Spina bifida occurs during the third and fourth weeks of pregnancy when a portion of the fetal spinal cord fails to properly close. This results in the child being born with a part of the spinal cord being exposed on the back.

While scientists do believe that there are genetic and environmental factors which act together to cause spina bifida, 95 percent of babies with spina bifida have parents with no family history of the condition. Women with certain chronic health problems run a higher risk (approximately 1/100) of having a baby with spina bifida.

There are three types of spina bifida:

Occulta: This is often referred to as ‘hidden spina bifida’ since the spinal cord and nerves tend to appear normal and there is no opening on the back. In this kind of spina bifida, there is only a small defect or gap in the vertebrae.

Meningocele: This form of spina bifida occurs when the bones do not close around the spinal cord and the meninges (three layers of membranes covering the spinal cord -dura mater, arachnoid mater, and pia mater) are pushed out through the opening. This causes a a fluid-filled sac to form. Off all the forms of spina bifida, this is the rarest.

Myelomeningocele: About 75 percent of all cases of spina bifida are of this kind. It is also the most severe of the three. In it, a portion of the spinal cord protrudes through the back. If it occurs in the bottom of the spinal cod, it may only affect bowel and bladder function. However, in the most severe cases, it can result in total paralysis of the legs with accompanying bowel and bladder dysfunction. Babies with spina bifida need the exposed spinal cord repaired to guard against infection and injury.

These are classified based on the location within the anatomy of the spine – vertebral column, spinal canal, intervertebral disc space and adjacent soft tissue.

Bacteria or fungal organisms can cause the infections occur after surgery, with postoperative infections typically occurring from three days to 3 months after surgery. The most common form of vertebral infection is ‘vertebral osteomyelitis) which may develop from direct open spinal trauma, infections in surrounding areas and bacteria that spread to a vertebra.

Infections involving the space between adjacent vertebrae are called intervertebral disc space infections. These can be divided into three subcategories: adult hematogenous (spontaneous), childhood (discitis), and postoperative.

Spinal canal infections include spinal epidural abscess, which is an infection that develops around the dura (the tissue that surrounds the spinal cord and nerve root).

Subdural abscess is more rare, affecting the potential space between the dura and arachnoid (the thin membrane of the spinal cord between dura mater and pia mater).

Infections within the spinal cord parenchyma (primary tissue) are known as intramedullary abscesses.

Adjacent soft-tissue infections include cervical and thoracic paraspinal lesions and lumbar psoas muscle abscesses. Soft-tissue infections tend to affect younger patients and are uncommon in older people.

Spinal infections can be caused by either a bacterial or a fungal infection in another part of the body that has been carried into the spine through the blood stream.

A bacterium called Staphylococcus aureus is the most common source of spinal infections. Escherichia coli is the next most common. The lumbar region tends to be the most commonly affected part of the spine. Spinal infections may occur after a urological procedure because the veins in the lower spine are located in the pelvis. Due to the nature of their addiction, intravenous drug abusers tend to be more prone to infections affecting the cervical region.

Treatment

Spinal infections are managed on a case by case basis depending on the clinical presentation and the imaging findings. Treatment can range from bed rest and antibiotics with bracing to aspiration of pus to surgical stabilisation and decompression.

Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the column. The tissue attachments cause the spinal cord to stretch abnormally.

The lower tip of the spinal cord is normally located opposite the disc between the first and second lumbar vertebrae in the upper part of the lower back. In people with spina bifida, the spinal cord does not separate from the skin of the back in the developmental stage. This prevents the spinal cord from ‘ascending’ as is normally the case. Thus, it results in the spinal cord being low-lying or tethered.

In some cases, the spinal cord may have fat at its tip. This could connect to the fat which lies over the thecal sac (a sac filled with fluid within which the spinal cord floats). This is called a lipomyelomeningocele.

Tethered spinal cord syndrome is a condition which is closely associated with spina bifida. So closely in fact, that an estimated 20% to 50% of children with spina bifida defects repaired shortly after birth will require surgery at some point to untether the spinal cord.

Treatment

Tethered cord syndrome is a condition which almost always warrants surgery particularly in a growing child to prevent the detrimental effects of tethering and stretch of the spinal cord. Surgery is safe and simple and consists of microsurgical division of the tethering elements including the filum terminale.