Consultancy Corner: ‘Scoliosis is not a curse’

Scoliosis is not a disease, but rather a term used to describe any abnormal sideways curvature of spine. The abnormal curvature can look like a broad ‘c’ or an ‘s’ when seen from the back.

This abnormal curvature of spine can be present right from birth (congenital) or can appear as the child grows. The most common forms of scoliosis are idiopathic (which means cause of scoliosis is unknown), and degenerative scoliosis (which appears due to aging of the spine). Scoliosis can also be seen in children with various neuromuscular conditions, for example as in polio, cerebral palsy, muscular dystrophy etc. Children with hereditary syndromes like Neurofibromatosis, Ehler-Danlos syndrome can also develop scoliosis. 

The congenital scoliosis is due to a defect in formation of the vertebral bone and may be visible from birth. These progress very fast and can lead to serious lung and heart problems. These children may require surgery even at a very early age. Timely surgery is usually the treatment of choice to prevent irreversible heart and lung problems.

Idiopathic scoliosis is seen more commonly in girls than boys (10:1 ratio). In children with idiopathic scoliosis, there is no noticeable symptom. The main problem is cosmetic appearance (if the curvature is more). Most often, idiopathic scoliosis is not very apparent. It is often noticed by parents or friends when there is a shoulder imbalance or a swelling at the back becomes visible. Scoliosis of lower spine may not be evident till it grows. Scoliosis of the upper spine can produce problems like pain, shoulder height variation, swelling in the back on either side, chest and heart problems (due to reduced space for lungs to expand within the chest cavity). Most developed nations have school screening programmes for scoliosis. 

The treatment for idiopathic scoliosis is based on two factors — skeletal maturity of the patient and the degree of spinal curvature. The child with scoliosis has to be evaluated by X-rays of the whole spine. The angle of the curvature is measured and is known as Cobb’s angle. The curve is further evaluated using bending X-rays and is called structural if the Cobb’s angle of the curve in bending X-rays is greater than 25 degrees.

If the degree of curvature is less (less than 20 degrees as measured in full X-ray of spine taken standing), regular observation is enough, which is done once in 6 months by the expert. If the person is in growth period and the curvature is more than 25 degrees but less than 45 degrees, bracing is required. Bracing is the treatment done by using close body-fitting moulded removable cast that hold your body straight in corrected position and prevents the scoliosis from progressing. 

Surgery is the treatment of choice if the Cobb’s angle in the standing X-rays is more than 45 degrees or if there is a progression of more than 6 degrees in six months duration in curve larger than 40 degrees. Scoliosis surgery is very safe and with modern techniques and implants, even severe curves can be corrected only by a surgery from behind and there is usually no need to correct the spine by opening the chest or the abdomen. 

Scoliosis associated with syndromes and neuromuscular conditions is developmental in nature and should not be confused with congenital scoliosis. Most often these children require surgery to re-establish body balance for nursing care. Intraoperative Neuro-monitoring is a method by which the functioning of the spinal cord and the nerves are monitored real time during surgery and is used nowadays routinely to avoid any bad outcome of surgery.