Deformities of Spine
Deformities of Spine
It is a condition in which the spine is curved sideways. It can happen at any age and every age group has different reasons that can cause it. In children, scoliosis is mostly seen in adolescents and in 80% of patients no specific cause can be found. This type is called as "Adolescent Idiopathic Scoliosis". Other causes of scoliosis in children include congenital vertebral anomalies ie abnormal development of vertebrae since birth. It can also be associated with conditions like neurofibromatosis, cerebral palsy, polio and other neuromuscular disorders, infections and tumors.
In adults scoliosis can be due to degenerative conditions of the spine, late presentation of vertebral anomalies or inflammatory conditions of the spine.
Signs and symptoms of early scoliosis are
- Uneven shoulder height when standing straight
- Prominence of ribs on one side making chest more prominent on one side as compared to other
- Unmatched waist creases
- Uneven hips and leg lengths
- History of spine deformities in the family
When the parents notice such signs it is advisable to consult a specialist early so that proper treatment can be instituted.
- Age of presentation
- Magnitude(Extent) of the deformity
- Growth potential in children - When such deformities are noticed at a younger age and if left untreated they tend to progress with the growth of the child
- Underlying Cause of the deformity
- Any other associated condition
Options include –
- Observation : lesser magnitude (smaller) deformities are observed by repeating X-rays every 4-6 months to see the progression of the deformity.
- Bracing : This might be indicated in patients who have a deformity which has a tendency to progress with growth but not severe enough to undergo surgical correction at initial stages.
- Surgery : This option needs to be considered only when the deformity is severe enough to not get corrected by bracing alone or when the deformity is impairing the quality of life by causing back pain, breathing problems or for cosmetic concerns.
Surgical procedure can either be a definitive spinal fusion surgery which is done when children have attained near adult growth of spine or it can entail the use of "Growing Rods" in very young children for whom definitive fusion is not recommended.
Kyphosis
It is the exaggerated front to back curvature commonly called as "Roundback or Hunchback". It is mostly seen in the upper and mid spine behind the chest (thoracic or thoracolumbar kyphosis). In rare cases it can even be seen in the neck (cervical kyphosis).
Common causes include
- Scheuermann's kyphosis – It is seen in adolescents causing hunchback and when severe can also lead to back pain
- Congenital Vertebral Anomalies
- Osteoporosis – It is a common cause in adults causing collapse of individual vertebrae and leading to kyphosis.
- Infections – Due to destruction of bony architecture and collapse it can cause a kyphotic deformity. Eg Tuberculosis of the spine.
- Trauma – Injuries of the spine can also lead to kyphosis
- Arthritis – Different types of arthritic conditions can involve the spine and can lead to kyphosis
Treatment
- Physical therapy : In posture related roundback and early Scheuermann's physical therapy in the form of posture adjustment and back extensor muscle strengthening can be helpful.
- Bracing : This also can be helpful in children who have a progressive Scheuermann's kyphosis and have some growth potential remaining. It can also be recommended in infections of the spine when proper antibiotics have been started, while waiting for the improvement in the bony strength and to avoid further collapse of softened bones.
- Surgery : In certain conditions surgery is the only option that can improve the overall alignment of the spine and prevent compression of the spinal cord due to progressive kyphotic deformity. In congenital deformities surgery is generally advised at an early age to prevent long term complications.