Scoliosis or Hunchback is a three-dimensional deformity of the spine characterized by sideways bend, backward bend, and twist. There are two main types of deformity of the spine which are scoliosis (sideward bend) and kyphosis (backward bend). Together they are termed Kyphoscoliosis.
Scoliosis can cause progressive bending leading to various complications if left untreated, and this emphasizes the importance of early detection and management.
There are six common types of scoliosis:
- Congenital scoliosis – noticed at birth and is secondary to the defective formation or segmentation of the spinal column (vertebrae).
- Idiopathic scoliosis is the most common type, but its cause is unknown. The commonest type of scoliosis, Adolescent idiopathic scoliosis occurs in 10-15 years of age, especially in girls.
- Degenerative scoliosis occurs in the ageing population 40-60 years of age because of laxity of the soft tissues around the spinal bones causing late onset of scoliosis.
- Neuromuscular scoliosis caused by muscle imbalance or paralysis
- Paralytic scoliosis (post-polio) and
- Syndromic scoliosis such as mucopolysaccharidosis (Hurler syndrome and Morquio syndrome), spondyloepiphyseal dysplasias etc.
In infants, the spine starts to bend during the first 2 years of age due to congenital defects of the spinal column like the hemivertebra. In this condition, the deformity is mild (10-30 degree curve) and can be fully corrected easily by excision of the hemivertebra and convex hemiepiphyseodesis surgery.
Adolescent idiopathic scoliosis occurs during the growth spurt when children grow in height and thus, making the curvature more significant. For e.g., if a 10 years old child with 25-degree scoliosis doesn’t receive treatment on time, it may become 60 to 90 degrees (severe scoliosis) by the time he/she is 16 years, which will require major correction surgery.
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The main challenge with scoliosis is the lack of awareness and lack of implementation of government screening programs. As it is a painless condition, it often goes unnoticed. However, in the West, diagnosis is very streamlined and school screening programs (Adam’s forward bend test looking for rib or loin hump) are in place for students of 10-15 years of age.
There is also a lack of information among people and healthcare professionals alike regarding the need for standing whole spine X-rays to detect scoliosis. Many times, standing whole spine X-rays are not available in most diagnostic centers or hospitals and supine X-rays can’t detect scoliosis when it’s mild.
Adolescent Idiopathic Scoliosis tends to worsen with growth, leading to increased curvature.
- Mild scoliosis of 10-25° is treated with observation and annual check-ups.
- Patients with 25-40° of curvature are offered Body moulded custom-made alkathine Brace and recommended Schroth exercises to prevent this condition from worsening speedily.
- Surgery remains the only resort if patients detect scoliosis when it is advanced (above 45-50° curves).
The Importance of Early Detection of Scoliosis:
In a world today where life expectancy is 70-80 years, it is unfortunate to lose a life due to a disease that can be managed so well in its early stage. The majority of patients approach a spine surgeon only when they start developing breathlessness and have multiple episodes of respiratory problems and ICU admissions due to the scoliosis curve.
Severe scoliosis can exert pressure on the lungs, making the lungs less functional. It can lead to restrictive lung disease and respiratory failure. Consequently, the heart also becomes hypertrophic due to the constant pressure from the restrictive lungs, resulting in right heart failure or cor-pulmonale. The cosmetic and psychological impact of deformed back in these young girls is under-reported.
Role of Robotics in the Management of Scoliosis:
Recent advancements in scoliosis surgical treatment have improved accuracy and patient outcomes. Navigation for the insertion of these screws and rods is a thing of the past, thanks to Robotic guidance systems, coupled with intraoperative O-arm (3-D imaging techniques, which allow surgeons to do patient and problem-specific planning and help in precise incisions as well as the positioning of screws and rods. It reduces the risk of errors during surgery and provides a three-dimensional orientation for optimal correction.
In patients, lesser tissue trauma and pain and faster recovery with early mobilization encourage rapid recovery and return to normal life. This combination greatly reduces radiation risk compared to that of pre-operative CT scans for Robotic guidance systems. Manipal Hospital Old Airport Road will become the first in India in a corporate setup to have robotic guidance – Mazor X Stealth Edition Spine Robotics and intra-operative O-arm guidance under the radiolucent table to assist high-risk patients with scoliosis correction surgeries.
During surgery, multi-modal neuro-monitoring is very essential to ensure the spinal cord is not excessively stretched. The neuro-monitoring system stimulates the brain and tracks the signal down the hands and legs, helping surgeons identify abnormal stretches and make necessary adjustments.
To conclude, we can’t deny that parents can play a huge role in detecting spinal issues in children. On the occasion of Scoliosis Awareness Month this June, we must look forward to spreading more words about this disease and encouraging parents to observe their children’s backs, and asking them to do Adam’s forward bend test. This can greatly help in detecting and reducing the increasing burden of scoliosis among growing kids.
(This article is authored by Dr. S. Vidyadhara, Chairman & HOD – Spine Surgery and Consultant – Robotic Spine Surgery, Manipal Hospital Old Airport Road, Bengaluru.) 