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Spine Surgery in India
Scoliosis Surgery in India
Our spine is an engineering marvel that supports our weight and ties our body together. The spinal column consists of a stack of small bones that range in size from 2-3 inches to 5-6 inches in diameter. When viewed from the front, the spine appears to be straight, but when looked at from the side, the normal spine has two gentle S-curves.
Scoliosis is an abnormal curvature of the spine. In scoliosis, the spine curves to the side when viewed from the front, and each vertebra also twists on the next one in a corkscrew fashion.
Scoliosis affects girls twice as often as it affects boys. About three to five of 1,000 people are affected. Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants.
What causes scoliosis?
In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis.
There are three other main types of scoliosis: -
- Functional: - In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
- Neuromuscular: - In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely, or they fail to separate from each other. This type of scoliosis develops in people with other disorders including birth defects, muscular dystrophy, cerebral palsy, or Marfan's disease. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
- Degenerative: - Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine.
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Exams and Tests in India
The physical exam involves having the child undressed from the waist up. The child faces forward with the feet straight ahead and the palms inward. With the knees locked, the child slowly bends over at the waist and tries to touch their toes. The doctor then looks at the spine for the appearance of straightness.
X-rays may be necessary in order to measure the curvature. Depending on the degree of the curvature and whether it gets worse over time, the doctor may recommend treatment.
What are the symptoms of scoliosis?
The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side that the other.
Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.
In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain. Additionally, there are other causes of back pain, which your doctor will want to look for as well.
How Is Scoliosis Treated?
Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.
Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. There is no direct treatment of the spine because the spine is normal in these people.
Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.
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Treatment of idiopathic scoliosis is based on the age when it develops.
In many cases, Infantile Idiopathic Scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.
Juvenile Idiopathic Scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.
Adolescent Idiopathic Scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. If the curve is between 25-40 degrees, a brace may be recommended. If the curve is greater than 40 degrees, then surgery may be recommended.
As explained above, scoliosis is not typically associated with back pain. In cases with back pain, the symptoms can be lessened with physical therapy, massage, and exercises, including yoga. These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.
There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse.
If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life. If this is not prevented, the person will eventually be at risk for heart or lung problems.
If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve.
People with degenerative scoliosis will often have more complaints of back and leg pain. This is related to the arthritis in the back and possible compression of the nerve roots that lead to the legs. Nonoperative treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery. X-rays and possible MRIs will be obtained to plan for surgery. The surgery could include only a decompression or removal of bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to stabilize the spine and possibly correct the abnormal curve.
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