Scoliosis

Scoliosis is a condition which is characterized by a curve in your spine. The angle of the curve determines whether the condition is mild or severe. If your spine is curved more than 10 degrees, it is classified as Scoliosis. The curvature of the spine is identified by doctors as C shaped or S-shaped, depending on the angle of the curve.

Scoliosis can be observed in people by the way they stand. People with scoliosis have their hips uneven. They may lean on one side while standing and may have uneven shoulders.

The very first symptom of scoliosis is usually spotted during puberty or when there is a growth spurt. Scoliosis may occur as a complication of muscular dystrophy or cerebral palsy.

Mostly the cases of Scoliosis in children are mild when they appear. However, depending on the angle of the curve, some kids develop severe scoliosis. The curve in the spine can worsen as they grow older. Severe bend in the spine will leave little room in the chest for the proper functioning of the lungs. This can lead to complications such as impaired lung function.  

Children who are diagnosed with mild scoliosis have to be carefully monitored regularly to check for any increase in the bend of the spinal cord. Most mild cases don’t require any treatment, however, regular X-rays are done to keep scoliosis in check.  Children with mild scoliosis are required to wear braces to stop the bend from increasing. Few cases that show severe symptoms may require surgical intervention.

Symptoms

The symptoms of scoliosis are usually spotted first by sports team coaches, teachers. The symptoms of scoliosis include:

• Shoulders look uneven
• Waist looks uneven
• Shoulder blade on one side sticks out more than the other
• Hips are uneven, with one hip higher and the other lower.
• A severe case of scoliosis may develop a rotating or twisting spine
• Ribs on one side stick out farther than the other in some cases of severe scoliosis

The symptoms in infants include:

●       The sleeping position of the baby may be consistently curved to one side.

• A bulge can be seen on side of the chest
• When complications with heart and lungs arise, there may chest pain and shortness of breath.
• Back pain can be seen in adults who had a history of scoliosis, although the pain may not be very severe.

Treatment of scoliosis is very critical at an early age itself. Complications like impaired heartburnand lung function will surface if scoliosis is left untreated.        

Causes                        

The exact cause of scoliosis is not known in most cases. When cause remains unknown it is termed Idiopathic. This category of scoliosis forms 80% of the scoliosis cases. In other cases of scoliosis, the cause can be divided into structural and non-structural.

1. Non-structural scoliosis can be due to :

• Muscle spasms
• One leg is longer than the other
• Inflammation of the appendix

Once the above cause is treated, scoliosis goes away.

2. Structural Scoliosis         

Structural scoliosis is the one in which the abnormal curve in the spine is present and it requires treatment. It doesn’t go away on its own. The causes for structural scoliosis include:

• Defects at the time of birth: Also called as congenital scoliosis, it occurs before the baby is born. The tiny vertebrae of the spine are not aligned properly in the baby during the development of the baby inside the uterus. It may be possible to detect scoliosis at the time of birth. However, in some cases, it may not come to attention until the child reaches the teens.
• Neuromuscular conditions like muscular dystrophy and cerebral palsy
• Spinal injury or infections of the spine
• Presence of genetic conditions like Down’s syndrome and Marfan’s syndrome.
• If one of your children has been diagnosed with scoliosis, there may be a possibility of scoliosis in the siblings. Hence, it’s best to get your children to get screened for scoliosis regularly.
• Girls are more likely to develop severe scoliosis than boys.
• Scoliosis may worsen as you grow old, the curve in the spine may increase with age. It’s better to get a regular screening if you had scoliosis in the past.
• Age is another factor in the development of scoliosis in adults. The spinal wear and tear as you grow older may lead to degenerative scoliosis.
• Infections and formation of tumors.

Diagnosis

  Diagnosis of scoliosis will be performed by your doctor by:

1. Physical examination: The doctor will perform the physical examination of your child by asking him to stand and bend down from waist at a 90-degree angle while keeping the arms loose. This position is ideal to identify any prominent rib cage on either side.
2. Neurological examination: Your doctor will test  for neurological complications such as abnormal reflexes, coma, piriformis syndrome numbness  in hand and feet and muscle weakness                                                      
3. Imaging

• Imaging techniques such as X-rays can show the curvature of the spine and the severity of scoliosis.
• Under circumstances that reveal a tumour to be the cause of scoliosis, the doctor will perform additional imaging such as an MRI.

Treatment

Kids who have mild scoliosis doesn’t usually need any treatment. However, doctors do regular screenings every 4-6 months to keep an eye on scoliosis.

The doctor may advise treatments based on the severity of scoliosis. It’s important to consider the following factors before opting for the treatment.

• Gender: The spinal curve tends to get worse with time more in girls than boys.
• The size of the curve: The bigger the curve, the worse it gets.
• S-Shaped curve: Also called as a double curve, the S-shaped curve gets worse with time than C shaped curve.
• The position of the curve: The curves that are positioned in the chest region or thoracic region of the spine tends to get worse more easily than the curves positioned in the upper and lower part of the spine.
• The growth of the child: Children who have stopped growing to have fewer chances of the curves getting worse. The braces are needed in children who are still growing.

The following types of treatments are available for scoliosis.

1.Braces 

Braces are the preferred method of treatment in growing children, who are at risk of worsening the spinal curve as they grow. The braces do not reverse or cure scoliosis but only prevent its progression.

Braces used for scoliosis are contoured fitting plastic materials that can be worn under the clothes day and night. The longer the brace is worn, the more effective it is in stopping the progression of scoliosis.

Close fitting braces are very snug that go under the arms, around the ribcage, and around the hips.  Braces can also be worn by children while participating in a number of activities and sports. They can also be taken off, for participation in some sports, if required.

The timeline when the braces can be permanently removed is when the children stop growing, for instance;

• 2 months later when girls get their first menstruation cycle
• When boys start getting facial hair as in beard and have to shave daily
• When your child’s height stops growing.

There are two types of braces that are usually prescribed by the doctor, which include:

• Thoracolumbosacral orthosis (TLSO) – this is the most common type of brace used for scoliosis because of its flexibility and comfort. TLSO brace is contour fitting and made of plastic. It is designed such that it complements the body curves and is almost invisible under clothing.
• Milwaukee brace – This type of brace is used when using TLSO brace is not able to stop scoliosis from progressing. Milwaukee brace includes a neck ring with rests for the chin and the back of the head. This brace covers the full torso.

2.Casting

Casting is done in infants instead of bracing. Casting helps to treat scoliosis in infants to help the spine grow back to normal position as the baby grows. Casting is done by using plaster of Paris. The infant’s body is covered by the cast, which has to be worn at all times. Since babies grow rapidly, the cast is changed frequently.

3.Surgery

When scoliosis reaches a stage when it gets very severe,  the doctor may recommend surgery. A surgical procedure called spinal fusion is performed by the doctors to reduce the severity of the curve of the spinal cord tumor.

• Spinal fusion

Spinal fusion is a surgical procedure that involves fusing of the two vertebrae of the spinal cord so that they don’t move. This is done by placing a bone-like material between the two vertebrae and a metal rod or wire is used to hold the curved part of the spine straight while the new bone material and the old bone fuse together.

In some kids, scoliosis may develop very rapidly. In such condition, the surgery is formed such that a growing adjustable rod is attached at the top and bottom of the spinal curve. TheSpine Surgeon will lengthen the rod every six months.

The next steps after the surgery involve Intensive care and recovery.

• Intensive care: The surgery maybe  4-8 hours long. The child is transferred to the ICU  (intensive care unit) after the surgery, where they will be given intravenous fluid and medications for pain relief. Mostly they can leave the ICU after 24 hours of observation. However, they will need an additional 10 days of hospital stay before getting discharged.
• Recovery: children recover around 6 weeks after the surgery and will be able to go back to school. However, they will have to wait longer to take part in sports. Doctors recommend waiting at least a year after the surgery to start sports activities. Some children may need to wear a back brace for 6 months, to support the recovery process and in some cases, a back brace is needed to support the spine for about 6 months.

The doctor will ask you to come back every 6 months to adjust the length of the rod, as your child grows. This is usually done as an outpatient procedure. Once your child has stopped growing and the spine has grown fully, the doctor will surgically remove the rods.

4. Exercises: The doctor may recommend certain exercises to be done regularly to help with scoliosis. They will help the child with scoliosis achieve a normal posture by realigning the spine, ribcage, pelvis, and shoulders. The theories and strategies on exercises for scoliosis vary, however, they all aim to get the spine back to normal.

Prevention

 Prevention of scoliosis is not possible because most cases of scoliosis are genetic. There are myths surrounding scoliosis are:

• It occurs due to sports injuries during childhood
• It occurs due to the lack of straight posture
• It occurs due to carrying the weight of the school bag
• Even though prevention of scoliosis may not be possible, it is important to inculcate a healthy and active lifestyle in young children which will help with their overall wellbeing and growth.
• Studies indicate that participation in sports and exercising regularly can benefit the child with scoliosis.

Living with scoliosis can be difficult for a child, especially a teenager. Teens are already overwhelmed with a flood of hormones and changing bodily functions. Being diagnosed with scoliosis can have a huge blow to the child’s self-esteem. Hence it is important to be very supportive of the child who is diagnosed with scoliosis.

Even though scoliosis is a non-preventable condition, it can be treated and managed to give the child a happy, healthy and active life.

Scoliosis, when diagnosed in young children should not be taken lightly. Children do not outgrow scoliosis. However, with the right treatment, it is possible to reduce the curve in the spine and stop it from worsening. It is important to seek immediate medical attention if you think your child is suffering from scoliosis. Scoliosis if left untreated, can lead to life-long deformity and arthritis, along with other major complications of lungs and heart. Call your doctor online and get the right medical help for your child with scoliosis.