SPINAL DEFORMITY: SCOLIOSIS / KYPHOSIS
I. Idiopathic & adolescent scoliosis
Scoliosis may present during early childhood or in teenage. It is progressive disease with worsening of the curvature, with or without neural compression, causing pain, weakness of limbs, bladder bowel dysfunction and sensory problems.
Scoliosis is an abnormal curvature of the spine. When viewed from the side, everyone has a natural gentle S-shaped curve of the spine. When looking at a person from behind, the spine should appear as a straight line from the base of the neck to the tailbone. If the curvature worsens over time it requires intervention. Small curves may not require any surgery. These are usually painless. The treatment is required only if the condition worsens and causes back pain.
Scoliosis in young should be picked up early for observation and early intervention, if needed. This is possible with the school scoliosis program.
Early onset scoliosis (EOS) is a variant of scoliosis that is present at very young age. Patient with EOS are initially observed and if necessary treated with cast, braces. All attempts are made to allow maximum growth of the spine before any definitive surgical intervention is needed.
Treatment involves deformity correction with spinal instrumentation( titanium implants) either all posteriorly ( from the back), anteriorly ( through the chest/ abdomen ) or both. This is major surgery, with risk of neurological deterioration during surgery, hence most major centres would perform this surgery under neuro-physiological monitoring. The surgeon is thus warned during surgery and corrective measures can be taken. If the spinal cord is found to be tethered this needs to be addressed first before the deformity is corrected.
Kyphosis is an exaggerated, abnormal rounding or curving of one or more vertebrae that affects the posture. People with kyphosis may appear to be slouching, or have a hunchback
Kyphosis can result from trauma, degenerative diseases, and problems during fetal development, infections, endocrine diseases, birth defects, spinal tumours and other factors.
Adolescent kyphosis, also known as Scheuermann's disease, results from abnormal irregularly shaped intervertebral discs and vertebrae, which cause the spine to bow. The problem becomes apparent in adolescence and may be painful and progressive.
Postural kyphosis, which can occur in adolescents and adults, also causes a bowed angle in the back, but in this case, the vertebrae and intervertebral discs are normal in shape, and the condition is not usually painful.
Kyphosis can also be seen in conjunction with scoliosis.