When seen from the front, the spine is normally a straight structure. Scoliosis is the abnormal curvature of the spine as seen from the front.
When seen from the front, the spine is normally a straight structure. Scoliosis is the abnormal curvature of the spine as seen from the front. When seen sideways, the spine has certain curvatures normally present in certain regions. When these convexities are reversed or exaggerated, they can lead to biomechanical problems. In medical parlance, these deformities are referred to as kyphosis or lordosis.
What is the cause?
These spinal deformities are caused by abnormal development of the bones and/or ligaments of the spine or abnormal nervous control over the spinal muscles, infections such as tuberculosis, swellings and tumours within the spinal canal, etc. Abnormal development can occur either within the mother’s womb or during the early or adolescent growth spurt.
How does it manifest?
Common manifestations include, the two shoulders being at different levels, the waistline being asymmetrical, an imbalance while sitting, an apparent feeling of one lower limb being shorter than the other one, a bony hump on one side of the back, abnormal flattening of one side of the chest wall, abnormal tilting of the head towards one side, etc.
There is a simple test that can detect early spinal deformities. This is done by asking the person to fold his hands and bend himself forwards without bending his knees. Observation can then be done from behind so as to look for any asymmetrical bump on any side of the midline.
How is it treated?
If detected early, these deformities can be treated by simple observation or special spinal braces. Regular observation is essential in many of these cases in the early stages.
The nature of surgery is decided by the severity of the deformity. In severe cases the surgery may be done in two stages, front and back. In certain types of deformities in the lower spine, the surgery may be done from the front alone.
This would decrease the length of the spine after which the surgery would be done. By means of using screws and/or wires and rods, the spine is held and twisted back into its normal shape as much as possible.
Major concerns
If one does not undergo surgery at the appropriate time, there maybe relentless progression of the deformity. As the spine gets progressively deformed, the chest cavity also gets compromised. Since the heart and lungs are within the chest cavity, this
compromise in the volume of the chest hampers the vital functions of heart and lungs leading ultimately to premature death.
Another major concern in these cases is the fact that as the spinal column gets deformed, the spinal cord is also stretched along with it and so the possibility of paralysis of the lower limbs also strongly exists in some of these cases.
What does the doctor say?
Surgery is essential when the deformity is progressively increasing on observation or when the deformity has reached a particular level of severity. It is also needed when the deformity pattern is known to have relentless progression or has led to a compromised function of the spinal cord.
Dr Yogesh K Pithwa, consultant spine surgeon, Hosmat Institute for Spinal Problems.
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