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 or 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.
A Case Study
Click here to read about a case study in Adolescent Idiopathic Scoliosis
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
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 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 cord, 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.