He developed a bendy spine at a young age. The mother first noticed it at about 9 years of age. By age 11 it was more pronounced, and they went to see the doctor. The doctor told the family not to worry and that it will correct itself. In any case, the doctor said, if not it may eventually need an operation. The operation can be done when he is 18 years old.
Well, Emmanuel came to see us in the clinic recently, He is 16 years of age now and the spine is curved so badly. He is now complaining of severe back pains and the deformity. Clearly, a big problem and one that requires an operation.
Bendy spine called scoliosis in medical terms can occur in all ages. Scoliosis in children between 10 and 18 years of age is termed adolescent scoliosis and can be due to many causes. By far the most common type of scoliosis in the adolescent period is one in which the cause is not known and is called idiopathic or adolescent idiopathic scoliosis (AIS).
Most patients are otherwise healthy and have no previous medical history. Approximately 30% of AIS patients have some family history of scoliosis, and therefore there seems to be a genetic connection.
There are many theories about the cause of AIS including hormonal imbalance, asymmetric growth, and muscle imbalance. It seems to begin as the children reach puberty and start growing. One side of the spine grows faster than the other side leading to sideways bending. It is often more apparent and more common in the chest (thoracic) area.
Adolescent idiopathic scoliosis generally does not result in pain or neurologic symptoms. The curve of the spine does not put pressure on organs, including the lung or heart, and symptoms such as shortness of breath are not seen with AIS. When scoliosis begins in adolescence, patients may have some back pain, typically in the low back area. Although it is often associated with scoliosis, it is generally felt that the curvature does not result in pain. Low back pain is not uncommon in adolescents in general.
There is a visible curve of the spine and one shoulder is higher than the other. One hip is also higher than the other and he walks with a slight limp and imbalance. This is often seen as some waistline asymmetry in which one hip appears to be higher than the other and may result in one leg appearing taller than the other. A prominence on the back or a rib hump secondary to the rotational aspect of the scoliosis is also obvious especially when he bends forward.
Treatment falls into three main categories (observation, bracing and surgery), and is based on the risk of progression. In general, AIS curves progress during the rapid growth period of the patient, and into adulthood if the curves are relatively large. Large curves are also more likely to progress or worsen.
Since scoliosis gets larger during rapid growth, the potential for growth is evaluated taking into consideration the patient’s age, the status of whether females have had their first menstrual period, as well as radiographic parameters.
Treatment by Observation
Observation is generally for patients whose curves are less than 25º who are still growing, or for curves less than 50º in patients who have completed their growth.
Treatment by Bracing
Bracing is for patients with curves that measure between 25º and 40º during their growth phase. The goal of the brace is to prevent the curve from getting bigger. This is accomplished by correcting the curve while the patient is in the brace so that the curve does not progress with time. Once the brace is discontinued, the best one hopes for is to not have any curve progression, and to remain at the curve magnitude present when the brace was started.
Surgical treatment is used for patients whose curves are greater than 45º while still growing or greater than 50 º when growth has stopped. The goal of surgical treatment is two-fold: First, to prevent curve progression and secondly to obtain some curve correction.
Living with Scoliosis
In general, AIS does not cause symptoms and should not restrict patients with respect to physical activities. For those patients who have mild scoliosis and who are being watched by their physician, all activities can be performed without any restriction or risk for injury.
For those patients who are undergoing brace treatment, all physical activities are allowed while the brace is not being worn. For patients who have surgical treatment, the surgeon will provide you with information as to what activities are allowed following treatment.
Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc, a Contributor to Newspackng, is a neurosurgeon with Brain and Surgery Consortium at 8 Buchanan Crescent, Off Aminu Kano Street, Wuse 2, Abuja.