DAVE WATTS, MD
Scoliosis is the abnormal curvature of spine giving the spine a “S” or “C” shape. Scoliosis can occur at any age and is more common in girls than boys. Larger curves cause discomfort while the smaller curves do not cause any problems. In most cases, the exact cause remains unknown.
Scoliosis is categorized into four major types based on the age of onset, cause and spinal curvature. They include:
Other types include neuromuscular, congenital and degenerative scoliosis.
Based on type of scoliosis, age of the patient, and severity of curvature the surgeon recommends either non-surgical or surgical treatment. Non-surgical treatment includes periodical observation with a 4 to 6 months’ intervals. If the curve is mild and patient has balanced patterns of malformation, it requires no treatment. Doctor will observe these changes by X-rays taken during the period of rapid growth. Braces or casts are used to control the compensatory curves adjacent to the congenital abnormality of vertebra to prevent them from worsening.
Surgical options include:
It involves removal of the abnormal vertebra and replacement of vertebrae with bone grafts. Two or more vertebrae are fused together with the help of bone grafts and internal fixators such as metal rods, wires, hooks, or screws to form one single bone. These internal fixators help stabilize the fusion and partially help straighten the spine. After the surgery, patients must wear cast or splint to promote the healing process.
In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed. The vertebrae present above and below the hemivertebrae are fused together with the help of metal screws. This procedure straightens the spine and allows the adjacent portion of the spine to grow normally. After the surgery, patients must wear a cast or splint to prevent mobilization and bring about fusion of vertebra.
Growth Rod Insertion
Spinal fusion surgery will not be effective in a growing child and may cause impairment of the chest and reduced growth of the lungs. Therefore, before going for surgery doctors recommend a procedure involving insertion of growth rods. One or two rods will be attached to the spine above and below the curve allowing the spine to grow while correcting the curvature. These rods will be left in place until the child is completely grown after which spinal fusion surgery will be performed.
Reconstructive Osteotomy and Instrumentation
This procedure is done if the spine deformity in children is causing breathing problems, pain and risk to the spinal cord, or impairment of the torso shape. In such cases osteotomy is done to remove part of the vertebral column and then followed by insertion of internal fixators such as metal rods, hooks, screws, and wires to restore the balance of the spine.
The doctor advises physical therapy after the surgery to help spine grow normally. Physiotherapists evaluate the posture, muscle strength, and flexibility and then design an exercise program suitable for the patient that helps control pain and improve the disability.