Scoliosis is the abnormal side to side curvature of the spine. The shape and size of the vertebrae in the cervical, thoracic and sacral segments result in a characteristic double ‘’S’’ shape of the vertebral column. The cervical spine is naturally bent with an inward curve, the thoracic is bent with an outward curve and the lumbar is bent with an inward curve. The natural curves of the spine help the spine in bearing weight and provide more flexibility in movement.
Scoliosis is defined as an abnormal “S” or “C” shaped curve in the side to side direction. The actual deformity is much more complex and occurs in the three dimensional space. Scoliosis may be classified according to the age of onset and the underlying cause of scoliosis.
Idiopathic scoliosis has no known cause of the abnormal curvature of the spine. Idiopathic scoliosis may be Infantile idiopathic scoliosis that affects children aged 3 or less. Juvenile idiopathic scoliosis affects children aged 4-10 and adolescent idiopathic scoliosis affects adolescents aged 10 – 18 years of age.
Adult scoliosis may be a remnant of adolescent scoliosis that was treated or left untreated. Degenerative spine conditions may cause scoliosis in the lower spine of the adults. Scoliosis may also occur as a part of a presentation of a syndromic disease. Neuromuscular diseases such as cerebral palsy may also cause scoliosis. In congenital scoliosis, the child is born with scoliosis.
The symptoms of scoliosis may just be limited to cosmetic abnormality. The patient with scoliosis may have uneven shoulders or waist. The head may not seem correctly placed in the line between the pelvis. The body may lean towards one side as the patient walks.
Back pain commonly accompanied scoliosis as the curve progresses. The patient usually complains of breathing difficulty as the severity of the curve increases. The heat and other organs may be affected in severe curves with curvature more than 100 degrees.
The diagnosis of scoliosis is made by the Orthopaedic spine surgeon after extracting thorough history and conducting physical examination. The diagnosis of scoliosis is aided with radiological studies that also help in planning the surgery if needed and to check the progression of the curve.
Special views of the X-ray are needed to correctly calculate the degree of scoliosis and further classify the disease. CT scan results in a more detailed image of the bony spine and an MRI gives information of the soft tissue structures in the spine (nerves, spinal cord, ligaments, disk, etc).
Most cases of infantile scoliosis resolve on their own by the age of 3 years. The physicians usually follow the patients every 6 months to check the progression of the curve. Infantiles in whom the progression of the curve is more than 5 degrees in a year may require casting to halt the progression and mould the deformity. The cast is changed every 2-4 months.
After a successful cast treatment bracing may be started. The bracing may also be done in children who do not tolerate casting. The operative procedure is reserved for patients in whom the curve progresses despite the casting/bracing.
Juvenile scoliosis with mild curves are regularly followed up every 6 months. Moderate scoliosis may be managed with bracing/casting and severe curves may require corrective surgery.
The surgery may involve fusion of the vertebrae either from the back or both from the front and the back. The fusion surgeries in children may result in abnormal prominence of the ribs in the case of posterior fusion and severe loss of height in case of combined fusion. Fusion led instruments such as growing rods and VEPTR (vertical expandable prosthetic titanium rib) system or growth modulation may be used to prevent the complications of fusion procedure.
Adolescent scoliosis is usually managed with frequent observation and bracing. The surgical correction of scoliosis in adolescents is done in cases of significant cosmetic deformity, uncontrolled pain and severe curves (>50 degrees).
The surgery may involve fusion of the facet joints or the vertebrae from the back with the help of screws/wires/cables. The prominent ribs may be corrected during the surgery. The corrective surgery may also be performed from the front in some patients. The corrective surgeries aim to correct the deformity and fuse the vertebrae to prevent further progression.
As with any surgical procedure there may be complications after the surgery. There may be neurological injury, infection, collapse of the lung or in some cases liquid/air may fill inside the chest cavity. There may also be a risk of failure of the surgery.