Scoliosis

The spine has normal curves if seen from the sides and is seen as a straight column from the front. But in certain conditions the spine shows curvatures from the front and it is called scoliosis. The abnormal forward bending of the spine is called kyphosis.

Scoliosis is a term taken from a Greek word meaning curvature. During the 19th Century physicians thought poor posture was the primary cause of scoliosis. Today scoliosis is known to be either congenital (present at birth) or developmental and may be hereditary. The disease causes the spine to curve to the side usually in the shape of an “S” or “C”. The curvature is measured in degrees. Adolescent Idiopathic Scoliosis is the most common type of spinal curvature. It occurs around the onset of puberty in otherwise healthy boys and girls. It is more common in girls. Physical signs may include uneven shoulders, one hip lower than the other, a rib hump when bent over at the waist and leaning to one side.

Whatever the patient’s age, the goal is to stabilize the spine to prevent additional curvature. Some patients with scoliosis are pain free and do not seek treatment until the deformity is noticed. Unfortunately, at that point it may be too late to treat the disease. The size of the curve is measured in degrees on an X-ray. The progression of scoliosis is monitored by periodic x-ray studies. When scoliosis is severe it may cause the spine to rotate, which can cause spinal spacing to narrow on the opposite side of the body. While minor deformities may be treated non-operatively, more severe and progressive ones require surgery.

Surgical Management of Scoliosis

Surgical treatment of scoliosis is employed if the curvature at detection is of greater magnitude. The aim of surgical correction is to achieve a well-balanced spine in which the patient’s head, shoulders and trunk are centered over the pelvis. This is done by using instrumentation to reduce the magnitude of the deformity and obtaining fusion in order to prevent future curve progression.

Usage of Staples

A more recent development in the treatment of Scoliosis is the use of staples on the convex side of the curve, which correct and maintain the curve till the patient is skeletally mature. These staples allow differential growth to take place i.e. less growing speed on the stapled side than the concave side thereby correcting the curve as the child grows. Special spinal implants made from Nitinol – a titanium based alloy has been studied extensively and is being employed clinically in a few centers in USA and Europe. The staples are in the shape of ‘C’ when they are manufactured at room temperature. When the staples are cooled to below freezing point the prongs become straight but clamp down into the bone in a ‘C’ shape when the staple returns to body temperature providing secure fixation. These are called Shape Memory Alloy (SMA) staples. As no fusion is done the child grows normally and even the residual deformity tends to improve with growth.

This novel procedure was performed for the first time in India at Apollo Hospitals, Chennai, on a 6-yr old girl, from a small town near Madurai, by the senior spine surgeon Dr. Sajan Hegde and his team.