There are a huge number of patients affected by scoliosis in Goa and due to a lack of adequate public awareness most of the patients don’t seek early treatment or get misguided and then unfortunately live their life with deformity and disability. NT BUZZ sheds light on scoliosis – a condition affecting one’s spine
Alisha Nicole Carvalho | NT BUZZ
Excerpts from a conversation with Dr Sunny Kamat, consultant spine orthopaedic surgeon at Manipal Hospital, Goa.
Q. What is scoliosis?
Scoliosis in Latin means abnormal sideways curvature of the spine. The human spine has natural curves at the cervical (neck), thoracic (upper back part) and lumbar (lower back) regions in the so-called sagittal (frontal) plane. These help us position the head over the pelvis and help to distribute body weight.
Scoliosis is broadly divided into congenital, neuromuscular and adolescent idiopathic. Congenital and neuromuscular scoliosis differ from adolescent idiopathic scoliosis due to the presence of vertebral anomalies and underlying neurologic disorder. Congenital scoliosis is distinguished from other types of scoliosis by the presence of vertebral anomalies at birth, which results in a mildly wedged or completely absent vertebral body. Although the vertebral anomaly is present at birth, congenital scoliosis generally does not develop until the growth phases of childhood or adolescence. Neuromuscular scoliosis develops due to underlying neuromuscular defect. Adolescent idiopathic scoliosis has no known cause and is also the most common type. It is seen mostly in girls.
Q. What are the characteristics of the condition?
Some patients will notice the physical appearance of scoliosis. This could be waist asymmetry, shoulder height difference, or prominent rib hump and apparent leg length discrepancy. Other children who have a severe curve may suffer from back pain. This pain can worsen with activity. Children with scoliosis often become self-conscious about their appearance.
Q. Can the condition be detected in a foetus?
No, it cannot be diagnosed in a foetus. It is clinically and radiologically diagnosed with the help of X-ray, CT scans and MRI.
Q. What are the consequences if left undiagnosed?
If left undiagnosed these are the problems that could arise:
Influence on lungs: Large curves can result in significant restriction of lung expansion during respiration which may eventually put pressure on lungs blood vessels and cause heart to enlarge (Cor pulmonale).
Influence on chest wall: The chest is a ventilatory box of which the spine forms one portion but which contributes substantially to the longitudinal growth of the box. Early spine fusion or insufficient spinal growth such as in multiple congenital vertebral anomalies will cause a decreased vertical growth of the box with subsequent decreased lung capacity. In addition, due to volume depletion, pulmonary function can be decreased by poor mechanical action from weak rib muscles, fused ribs, or inefficient ribs motion.
Back pain: Due to a bent spine there is unequal distribution of body weight which causes biomechanical stress on spine and pelvis which eventually results in muscle fatigue and pain.
Appearance: The spine’s appearance is often a major concern and a frequently unspoken but important treatment outcome.
Q. What are the treatment options available? How long does one need to follow the treatment?
Treatment of scoliosis depends upon severity of the curve and associated spinal abnormality.
Most of the times scoliosis is treated conservatively with observation and bracing.
Observation is indicated for skeletally immature children. In these children, close radiographic and clinical follow-up is recommended.
Bracing remains a challenging issue for patients, parents and physicians due to its poor compliance by patient. Bracing is recommended for skeletally immature patients. The functional goal of bracing is not to reverse the scoliosis but rather to prevent or retard the progression of the deformity by applying a force to the flexible and deformed
spine.
However, scoliosis can also be corrected instantaneously through surgical methods. The goal of surgery is to obtain a balanced and stable spine.
Q. What is the quality of life of those living with scoliosis?
If the curve of scoliosis is very severe it can severely affect the quality of life. A patient may develop breathing problems and frequent lung infections due to small lung volume. One may develop breathlessness with mild physical activities, paralysis, unpleasant appearance due to hump back which may eventually impact the child’s confidence and psychology, etc.
Q. How can awareness be created for people to seek medical assistance in time?
Innovation and investigation have occurred in scoliosis treatment in the past several years. With advances in science, this complex disease can be cured and can give patients a ray of hope for living their life without disability and deformity. More screening camps should be organised in schools and community centres to diagnose scoliosis at an early stage so that it can be treated accordingly.