Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people develop abnormal sideways curvature in the spine that is called scoliosis. The sideways bend results in the ribs becoming prominent on one side. This prominence is referred to as ribhump or razorback. This ribhump is perceived as a deformity by the patient and their parents and if it is severe it can result in a deformity that is obvious even when covered with clothes
How to diagnose scoliosis?
Patients with scoliosis may notice one shoulder to be higher than the other. They may have a shoulder blade prominent, asymmetrical breasts, asymmetrical waistlines and a tilted pelvis with one hip more prominent than the other.
On an x-ray, the spine of a person with scoliosis looks more like an “S” or a “C” than a straight line. On Xrays, the severity of the scoliosis curve is measured by an angle called Cobb angle. For proper evaluation of scoliosis, your spine surgeon may order X-rays (AP and Lateral views) of Whole Spine (showing from neck to the hips in one film). Right and left bending Whole Spine X-rays and X-rays done under traction (pull) may be required if planning a surgery for Scoliosis. MRI of the Whole Spine will be required in all cases with Congenital Scoliosis and in Adolescent Idiopathic scoliosis where surgical correction is planned.
Does scoliosis always need surgery?
When Cobb angle is more than 50 degrees, scoliosis almost always needs surgery. Curves less than 30 degrees usually do not need surgery. Braces like Milwaukee brace and Boston brace may be used for curves between 20 and 50 degrees. Curves more than 80 degrees can compromise the functioning of heart and lungs and should always be corrected with surgery. Corrective surgery for scoliosis is usually performed from the middle of the back. The curvature in the spine is corrected using titanium screws and rods and the bones involved in the curvature are then fused together so that the curve does not progress any further with growth.
Common myths about scoliosis
Scoliosis does not come from carrying heavy things, athletic involvement, sleeping/standing postures, or minor lower limb length inequality. Patients with scoliosis should do lots of stretching exercises as in hanging from an overhead monkey bar. Swimming and yoga are also beneficial.
What are the types of scoliosis?
Adolescent Idiopathic Scoliosis – The most common type of scoliosis is Idiopathic scoliosis (called so because there is no apparent causative factor). This is most common in teenage girls. The rapid increase in deformity coincides with their pubertal growth spurt. These girls generally seek medical attention because of their deformity. If the curve is expected to reach more than 50 by the time they finish their growth, then corrective surgery will be required.
Neuromuscular Scoliosis – Neuromuscular scoliosis is the next most common type of scoliosis, which occurs in individuals with neuromuscular disorders like Cerebral Palsy, Polio, traumatic paraplegia, muscular dystrophies, etc. Severe C shaped curves with a significant pelvic tilt characterizes this type of scoliosis. Scoliosis results in difficulty with sitting in a wheelchair, impingement of ribs on hips, pressure sores and difficulty in nursing care. Mild curves can be managed with a brace, but moderate and severe curves usually need corrective surgery.
Congenital Scoliosis – Some kids may be born with an anomaly in their spinal bones such that there is progressive bend in the spine with the growth of the kid. Such cases may be associated with Spinal Cord Malformations and always need an MRI Whole Spine to look at spinal cord anomalies. If the curve is progressive, then they almost always need surgery. New techniques like Growth Rod and VEPTR have allowed us to control the curve, while allowing growth of the child so that the child does not end up with a short truck from a spinal fusion very early in life.
Syndromic Scoliosis – Syndromes like Neurofibramatosis, Marfan’s, Osteogenesis Imperfecta, etc may be associated with scoliosis. The management of scoliosis in these conditions needs a few factors to be considered with respect to the underlying condition.
Degenerative Scoliosis – This type of scoliosis usually affects women > 60 years age. It is a result of extensive wear and tear in the spine as a result of aging. This may be associated with pinching of the nerves (lumbar canal stenosis) and lumbar degenerative kyphosis (forward bending of the lower back). Degenerative scoliosis and lumbar degenerative kyphosis together form different spectrums of Adult Deformity or Adult Sagittal Imbalance. Even though the curves are mild to moderate (rarely > 30), they may be very disabling because of severe low back pain and nerve compression. If symptoms of the patient are very disabling, then a long posterior fusion down to the pelvis along with decompression will benefit these patients.
What to expect while preparing for scoliosis surgery?
Scoliosis surgery is a complex spine surgery that is performed in only a few centres worldwide. We at Spine Surgery International have special expertise in dealing with complicated scoliosis cases. Our team of Spinal Surgeons have performed scoliosis surgery on children and adults from many countries. We perform this surgery under Neuromonitoring to ensure maximum safety against paralysis and spinal cord injury for our patients. We use new technology namely Carm, Pedicle screw instrumentation, High Speed Burr, Microscope, Navigation and Neuromonitoring to make scoliosis surgery successful.
The curvature in the spine is corrected using titanium screws and rods and the bones involved in the curvature are then fused together so that the curve does not progress any further with growth. We also perform growing rod surgery and Magic rod surgery for non fusion scoliosis surgery in young children less than 10 years of age.
Typically, the child spends a couple of days in the ICU after scoliosis surgery and starts walking after 2-3 days. Most kids are out of the hospital in 5-6 days and are able to travel back to their country in 2-3 weeks time. They can join back school after 4-6 weeks of their scoliosis surgery.
Scoliosis surgery has a success rate of about 98% in the hands of our expert spinal surgeons. Approximate cost of scoliosis surgery at the best hospitals in India is 12000 to 16000 USD.
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