A Spinal deformity is an abnormal curvature in the spine. Scoliosis is an abnormal sideward curvature in the spine. Kyphosis is a abnormal forward bend in the spine. Most of the scoliosis and kyphosis deformities cause only a cosmetic deformity without affecting the functional ability. Identifying them early is important because some of them can cause severe deformity and disability.
Congenital spinal deformities: A defect in the process of development of the spine in the human foetus can lead to an extra bone on one side or one half of the spine. This can lead to faster growth on one side of the spine, resulting in an abnormal curvature. Interestingly, although these are present at the time of birth, they may not be noticeable. Some of these can rapidly worsen as child grows and cause severe deformity at a very young age.
Neuromuscular spinal deformities: Neurological or muscular disorders like cerebral palsy, poliomyelitis, myopathies etc can affect the spinal muscles that support the spine. Weakness in the spinal muscles results in the spine collapsing into a curve.
Idiopathic scoliosis: There is no apparent cause for iiopathic scoliosis. This is the most common type. Commonly diagnosed after the age of 10 years and in adolescents.It is more common in girls. The most common concern is a cosmetic deformity. Only the severe ones may affect the lung capacity and cause functional disability.
Sometimes, bone destruction or loss by infections or fractures or some tumours can also lead to spinal deformities.
Based on the cause and age group, there are different types. One such subset is “Early onset scoliosis”. Scoliosis diagnosed in children below 6 years of age is an early onset scoliosis. A spinal deformity at this age causes a deformed rib cage and restricts the growth of the lungs. This leads to limited development of the kids’ breathing capacity.
One can imagine that a stiff and deformed chest wall restricts lung expansion while breathing. This puts additional load on the heart as it pumps the blood into the lungs. Over a few years, this chronic overload results in heart failure and lung failure at a young age and thereby leads to an early mortality in this group of spinal deformity patients. This effect is more profound in those with neuromuscular disorders with already weak respiratory muscles.
The awareness about spinal deformities amongst the people is very low in our country. A mild deviation in the back of the small kid may be often ignored as a harmless anomaly. Soon, as the kid grows, the deformity becomes worse and then there is a tendency to hide the problem because of the social stigma traditionally attached to such deformities. This leads to a loss of time and precious opportunity to correct the deformity at the right time.
The other problem is misinformation that there is no treatment for such deformities. The paediatricians play a key role in identifying these deformities early and guiding the parents in the right direction. A spine surgeon’s opinion is very important even in the early and mild deformities so that they can be followed periodically to monitor the curve.
Proper treatment at the right time can prevent severe spinal and chest wall deformation, thereby preventing restriction of lung and heart function and remove the risk of early mortality in them. Treatment options include plaster casts or braces and surgical correction.
Surgical correction can be done in some cases at an early age. Some need surgical techniques that allows growth of the spine while controlling the deformity in the initial years. Once the child reaches an age of 10 to 12 years, a final fusion procedure is done.
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