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Scoliosis

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Overview

Lateral curvature of the spine, scoliosis, is most frequently identified in adolescents. Adults with abnormalities such as cerebral palsy and muscular dystrophy are most frequently affected by scoliosis. However, what causes scoliosis in children is unknown.

The majority of scoliosis instances are moderate. Some curvature gets worse as a child grows older. Severe scoliosis can cause more difficulty for the lungs to function properly if there is less room in the chest due to a particularly severe spine bend. Most often, no therapy is required. Some kids may need to wear a brace to prevent the curvature from worsening. Others may require reconstructive surgery.

Types of Scoliosis

  • Congenital: Congenital scoliosis occurs when the baby's back develops before birth. The spine may bend due to issues with the vertebrae, the tiny bones in the back. There might be missing vertebrae or improper division of the vertebrae. When the infant is delivered, doctors can identify this rare issue. Or perhaps they won't discover it till they are teenagers
  • Idiopathic: Scoliosis with an unknown cause is referred to as idiopathic scoliosis. In most cases, doctors cannot identify the precise cause of a bent spine
  • Neuromuscular: Spina bifida, cerebral palsy, or spinal cord damage can lead to neuromuscular scoliosis. The muscles may occasionally get damaged by these disorders, preventing them from properly supporting the spine. This might cause the back to bend
  • Degenerative: Adults can develop degenerative scoliosis. It often appears in the lower back when the spine's discs and joints start to deteriorate with age

Symptoms of Scoliosis

Scoliosis symptoms include:

  • Sagging shoulders
  • One shoulder blade is more noticeable than the other
  • Unstable waist
  • One hip is higher than the other
  • The rib cage is bulging forward on one side
  • There is an incline on one side of the back when leaning forward
  • Lower back pain
  • Stiff back
  • Fatigue due to muscular tension
  • Leg ache and numbness (from pinched nerves)

In most cases of scoliosis, the spine will rotate or twist in addition to bending in one direction. As a result, the muscles or ribs on one side of the body extend farther than on the other.

Causes of Scoliosis

In some families, scoliosis is hereditary. Doctors believe genetic factors may be involved in the most common kind of scoliosis. Scoliosis can be caused by

  • Muscular dystrophy 
  • Neuromuscular diseases such as cerebral palsy
  • Birth defects that impact the spine's bone growth
  • Anomalies in the spinal cord
  • A child who had previous chest wall surgery
  • Genetic disorders like Down syndrome and Marfan syndrome
  • Spine-related injuries or illnesses
  • Infections and tumours

Diagnosis of Scoliosis

While conducting a physical examination, the doctor might ask the patient to stand and bend forward from the waist with their arms hanging loosely. This is done in order to inspect the patient's rib cage and determine if one side is larger than the other. The physician could also do a neurological examination to look for the following:

    • Muscle tremors and weakness
    • Unusual reflexes
    • Numbness

The doctor may recommend the following tests:

  • Imaging tests: X-rays can confirm the scoliosis diagnosis and reveal the severity of the spinal curvature. Because numerous X-rays will be taken over the years to see whether the curve is deteriorating, repeated radiation exposure may become a worry. Ultrasound can also be performed. However, it may not be accurate in assessing the degree of the scoliosis curve
  • MRI is performed when the doctor believes an underlying condition, such as a spinal cord anomaly, is causing scoliosis

Scoliosis Treatment

Depending on how severe the bend is, scoliosis treatments vary. Most children with really minor curves don't need any therapy, although they might need recurrent check-ups to evaluate if the curve is getting worse as they age.

Braces or surgery may be required when the spinal curvature is moderate or severe. 

  • Braces: A brace may be suggested if a kid has mild scoliosis. The brace is made of plastic and is moulded to fit the body. Since it fits under the arms and wraps over the rib cage, lower back, and hips, the brace is nearly undetectable when worn under clothing.
      Most people wear their braces for 13 to 16 hours each day. The more hours a brace is worn, the more effective it becomes. Children with braces typically have few limitations and can engage in most activities.  A brace can not cure or correct scoliosis, but it typically prevents the curvature from worsening
  • Spinal fusion: Scoliosis cannot be cured or corrected with a brace, although it may usually be stopped from getting worse. Braces are taken off when there are no more height changes
  • Expanding rod surgery: If scoliosis develops quickly at a young age, surgeons may place expandable rods along the spine that can change in length as the child grows. The rods are surgically or remotely extended every three to six months in the clinic
  • Vertebral body tethering surgery: During this surgery,  small incisions are made. Screws frame the abnormal spinal curvature, and a sturdy, flexible cable is threaded between the screws. The spine straightens when the cord is tightened. The spine may become even more straight as the child grows

Risk factors of Scoliosis

The following are risk factors for scoliosis:

  • Age: Teenagers and adolescents are at higher risk; this is when the symptoms first appear
  • Sex: Females are at more risk than men of developing scoliosis
  • Family background: Scoliosis can be hereditary in some families, although most youngsters with the condition have no family history

Complications of Scoliosis

Scoliosis often lead to the following complications-

  • Breathing difficulties: When scoliosis is severe, the rib cage may press on the lungs, making breathing more difficult
  • Back conditions: People who experienced scoliosis as children are more prone to develop persistent back pain as adults, particularly if their abnormal curves are severe and untreated
  • Appearance: Scoliosis can cause more visible abnormalities as it progresses, such as lopsided hips and shoulders, bulging ribs, and a tilting of the waist and trunk to one side. Patients with scoliosis frequently feel self-conscious about their looks

Prognosis of Scoliosis

The severity of the curve affects how scoliosis progresses over time. The condition does not interfere with daily activities and functions in mild to moderate situations. People with severe scoliosis may experience physical difficulties.

Being scoliosis-affected might be challenging. A person can join a support group if they need assistance controlling scoliosis. They can get encouragement and guidance on how to manage the disease daily.

Review

Reviewed by Dr. Anil Kumar Kansal - Principal Director & HOD- Neurosurgery, Spine Surgery, Robotic Surgery, Neurosciences. 


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