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Times of India
05 March 2012
By Umesh Isalkar
Pune India
Surgeons Say Early Diagnosis of Scoliosis, Treatment May Do Away With The Surgery

Anita’s gait was odd, she walked with a one-sided tilt. When she was eight, her parents noticed that the spinal bone close to the shoulder blade had protruded a bit and as she grew older, it started grew prominent. By the time she was nine, the bone jutting from the spine became a worry.

Doctors diagnosed the girl with a spinal deformity called scoliosis and advised surgery. Anita is among the few who got treatment in time. Doctors say that progressive scoliosis, if untreated, can result in deformity and cause psychological distress.

"The spine, or backbone, helps hold the body upright. Without the spine's gentle curve down the back, we wouldn't be able to balance, walk, or move properly. But the spine curves from side to side in people with a condition called scoliosis," said spine surgeon Ketan Khurjekar, head of the spine department at Sancheti Hospital.

Correcting That Curved Spine

The prevalence of scoliosis is four in 1,000 adolescents. Khurjekar sees around 8 to 10 scoliosis patient every month. Among them four get operated for spinal deformity correction.

Another spinesurgeon RajeshParasnis,head of spine department at Oyster and Pearl Hospital said, "Scoliosis affects 2% of women and 0.5% of men in the general population. A majority of the curves are mild (81.25%)." He sees six to eight patients every month, among them two to three undergo surgery every month.

Scoliosis can be idiopathic or due to cerebral palsy, polio, congenital spinal deformities, limb length deformity, genetic conditions, muscular dystrophy, neurofibromatosis, spina bifida, tumors etc. "Over 80% of scoliosis is idiopathic which means that there is no known cause. It can be found even in healthy people," Parasnis said. Many cases are found in consanguineous marriages. "Three to four percent of adolescents will be found to have some form of scoliosis. Most of these will be girls, in which curves may be more progressive. It is four times common than boys," say experts.

Getting help early is the way ahead. "Often, the first indication is when a child or the parent notices that clothes no longer fit well (the legs of the trousers may seem uneven). Similarly, the shirt or a kurta is tighter on one side of the body," said Khurjekar.

Symptoms of scoliosis include obnoxious flank or upper back prominence, back pain, leg length discrepancy, an abnormal gait, and uneven hips. Patients may have one shoulder higher than the other, a 'prominent' shoulder blade and rib cage when bending forward, and visible curving of the spine to one side, he added.

"Every time, surgery is not the only solution. For very small kids plaster techniques and body molded jackets, called as braces or corsets are good options to prevent further progression of scoliosis," Khurjekar said.

Correcting That Curved Spine

Experts said that less than 50 % patients come to them at the right age for treatment. However, many girls along with their parents approach doctor for spinal deformity or back correction when they attain marriageable age. Many boys seek treatment when they are independent and earning.

"After the maturity and after the age of 20 years, spinal deformity (scoliosis) becomes very rigid and it is very demanding to perform surgery. In adulthood when surgery is performed, it has more extent of surgical morbidity," said Khurjekar who has a series of patients in whom surgery has been performed in adulthood with good results.

Do Schools Have A Role To Play In This?

"School screening can detect scoliosis early. Generally, it should be carried out for girls in seventh standard. By that time they are in adolescence and scoliosis appears," said Khurjekar, an active member of Scoliosis Research Society, an apex organization worldwide.

He has plans of taking a screening camp in Pune soon.Recently, he examined three girls from prime institutions in Pune. Two were from standard VII and one was from standard X. "This means that scoliosis can affect anyone irrespective of socio-economic background," he added.

Parasnis Also Believes That School Screening Can Help Detect Cases At Early Stage

"School screening conducted periodically helps in detecting scoliosis at early stage as teachers spend more time with the children. Early consultation can help patient in getting good results and do help in preventing the progression," Parasnis said.

What Is Scoliosis?

Everyone's spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can't be corrected simply by learning to stand up straight. This condition is called scoliosis. On an x-ray, the spine of a person with scoliosis looks more like an "S" or a "C" than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person's waist or shoulders appear uneven.

Do I Have Scoliosis?

www A physician performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. www You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence).

www The physician will usually take initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.

Surgery, for whom?

ll Surgery may be recommended for curves in excess of 40 degrees. ll Also patients who have impending neurological deficit (risk of paralysis) ll Patients having difficulty in breathing ll Patients with truncal imbalance, awkward cosmetic deformity which is progressing definitely needs surgery. ll Patients who have shown rapid progression in consecutive six months follow up

Severe scoliosis of the spineapproximately 90 degrees

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