Scoliosis and other spine deformity :

1) Scoliosis :

Scoliosis is a sideways curve in your backbone (or spine). Often, it first shows up when you're a child or teenager. The angle of the curve may be small, medium or large. But anything that measures more than 10 degrees on an X-ray is considered scoliosis. Doctors may use the letters "C" and "S" to describe the curve. Normally small curve is less than 60 degrees, medium between 60-90 degrees and large is more than 90 degrees. scoliosis may be as a result of Bony defect (called as congenital scoliosis) or as a result of nerve or muscle problem (called as neuromuscular scoliosis) or there may not be any underlying pathology at all.(called as idiopathic scoliosis)

What are the types of scoliosis?

i) Congenital: since birth due to Bony defects.

ii) Neuromuscular : may be present since but  may develop letter due to muscle imbalance.

iii) Adolescent idiopathic scoliosis : most common type of scoliosis. Without any obvious call. But can lead to bony changes and muscle imbalance in long run.

iv) Adult denovo scoliosis : occurs because of age-related degeneration in disc and spine joints.

Kyphosis :

Kyphosis is a spinal condition in which, the spine curves forward more than it should ( more than 60 degrees). As a result, the upper back looks overly rounded. The curvature can make people looked hunched or slouching. People sometimes call it ‘hunchback’ or ‘round back’. It is mostly because of infection or some fracture or some form of Bony abnormality like fused vertebra or incompletely formed vertebra in the spine. Sometimes kyphosis can be because of age related weakening of the vertebras and age related Bony fractures in the spine.

2) Kyphoscoliosis :

Kyphoscoliosis is a combination of outward curvature (kyphosis) and lateral curvature (scoliosis) of the spine.

Proven methods to fully correct spine deformities

Common treatments for spinal deformity from non-surgical to surgical include:

i) Observation and monitoring, particularly in young children, to ensure the spinal curvature does not progress. This is usually done if the child is less than 10 years of age and the curve angle called as cobbs angle is less than 40 degrees.

ii) Bracing to hold the spine in alignment. bracing allows the curve to correct slowly or hold the curve in same position till the final surgery is done.

iii) Physical therapy and lifestyle changes to include more exercise in order to strengthen back muscles. Children are encouraged to do back and abdomen exercises to keep the muscles around the spine strong. This is very important for holding the curve incorrect position before surgery and after surgery it helps in early mobilisation of the kid.

iv) Finally surgery is the ultimate solution if the curve is of congenital origin or is more than 40 degrees in case of neuromuscular or idiopathic variety. Fusion surgeries include procedures like putting screws and rod along with cutting the bone as specific positions called as osteotomies or vertebral column resection to strengthen the spine.

v) Surgery for a spinal deformity can range from minimally invasive to very complex. the length of surgery may vary from 4 hours to 14 hours depending on the complexity of curve and the correction required. some Times the surgery is done in 2 stages, 3 days apart if the surgery includes cutting the bone at the apex of the curve called as vertebral column resection .

What age is best for scoliosis surgery?

i) For Children with scoliosis since birth (congenital): 3-5 years of age.

ii) For children (Adolescent idiopathic scoliosis ) : between the ages of 11 and 13 years for girls and between the ages of 13 and 15 for boys.

iii) For adults : Any age whenever the deformity presents

iv) For neuromuscular scoliosis: Normally after the age of 10 years

Scoliosis Surgery Recovery Timeline :

Every patient’s recovery journey is different, so take this timeline with a pinch of salt and listen to your surgeon – they’ll give you the best idea of what to expect in the weeks and months following surgery.

First 7 Days After Surgery :

Generally the patient gets discharged from the hospital within 3-7 days if there are no complications.

Although they need rest for a few initial days, your physiotherapist would assist you to make you stand and walk for a short distance on the very next day of surgery, followed by which, you should be able to perform some small daily tasks that don’t require bending or lifting within a week!

At home instructions are given at the time of discharge from the hospital including the schedule of exercises, diet plan, medications etc.

1 To 2 Weeks After Surgery :

Normally with good wound care, the sutures are removed after 2 weeks from the date of surgery. This is the time when the dressing can be taken and and the patient can have a proper bath.

At the same time, to prevent infection, it is important to keep the area dry and clean.

3 To 4 Weeks After Surgery :

With efficient physical therapy and rehabilitation, most of the children would go back to schools and adults can start their office work too, with some limitations to be kept in mind, for example – avoid vigorous activities like running, jumping, lifting heavy objects, etc.

Light exercises as per the scheduled shall be continued.

6 To 12 Weeks After Surgery :

Around 6 weeks post-op, is the time to step up the exercise plan after a proper consult with your surgeon and the physiotherapist.

You might need an Xray at this stage if indicated.

6 Months To 12 Months After Surgery :

At this stage you must see your surgeon for a final recovery status, and most of the patients can resume nearly all activities (including contact sports) between 6 and 12 months after surgery. This solely depends and varies with every patient.

Recommendation: Always consult your doctor before starting or resuming contact sportsand other more extreme activities, such as rock climbing or bungee jumping.

Potential Complications Of Delayed Surgery Or Not Going Ahead With The Surgery Includes :

i) Lung problems that include difficulty in breathing due to severe curvature of the mid-back ,pressing onto the lungs and giving limited space to the lungs for expansion .

ii) Inability to perform activities of daily living, such as walking or dressing, due to postural problems from a curved spine. This can be made worse by progressive nerve and muscle weakness in the pelvis and lower limbs over a period of time.

iii) Loss of sensation in the legs, incontinence, or reduced sexual function due to nerve compression in the lower back . It is important to understand here that in case of large curves which are over 100 degrees in cobb's angle measurement this type of progressive paralysis eventually develops over a period of time. Sometimes it can develop very rapidly over a period of few months in case of kyphoscoliotic deformity of spin specially as a result of traumatic or infective primary pathology.

iv) Pain due to compressed spinal nerves or muscle spasms. slowly as the curve progresses eventually pain develops at the back in all types of scoliosis due to degeneration of facet joints and disc in the spine.

v) Extreme cases of curve angle more than 140 degrees may cause the curved spine and the ribs to start pressing the internal abdominal organs also leading to difficulty in eating and digestion, and frequent symptoms like vomiting and abdominal pains .