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:
- Structural Scoliosis
- Non-structural Scoliosis
- Idiopathic Scoliosis
- Infantile scoliosis
- Juvenile scoliosis
- Adolescent scoliosis
Other types include neuromuscular, congenital and degenerative scoliosis.
Based on the type of scoliosis, age of the patient, and severity of curvature the surgeons recommend either non-surgical or surgical treatment. Non-surgical treatment includes periodical observation at 4 to 6 months intervals. If the curve is mild and the patient has balanced patterns of malformation, it requires no treatment. The 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 that are adjacent to the congenital abnormality of the vertebra to prevent them from worsening.
Surgical options include:
Spinal fusion – It involves the 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 are used to form one single bone. These internal fixators help to stabilize the fusion and partially help to straighten the spine. After the surgery, patients must wear a cast or splint to help in the healing process.
Hemivertebra removal – In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed and the vertebrae present above and below the hemivertebrae are fused together with the help of metal screws. This procedure helps to straighten 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 the vertebra.
Growth rod insertion – Spinal fusion surgery will not be effective in a growing child and may cause impairment of the chest and 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 spine deformity in children causes breathing problems, pain and risk to the spinal cord, or impairment of the torso shape. In such cases, osteotomy is done to remove a 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.
Physical therapy – Doctors advice physical therapy after the surgery to help the spine grow normally. Physiotherapists evaluate the posture, muscle strength, and flexibility and then design exercise programs suitable for the patient that helps to control pain and improve the disability.