Scoliosis-Spine Surgery in India.
Our spine is having a normal curvature. But when the otherwise straight spine becomes sidewise ( Lateral) or abnormally curved,it needs a review by a Neurologist or spine specialist and possibly a surgery by a specialist spine surgeon to correct the deformity.At CMCS Health we are associated with best and experienced Spine Surgeons in India and Best equipped and well managed indian hospitals for Scoliosis-Spine surgery in india for our global guests.
What is Scoliosis?
Scoliosis is an abnormal sidewise or lateral curvature in otherwise straight spine.When a person with scoliosis is looked at from the front or back the abnormal curvature is visible in the gait or posture of the person.
When the spine has an abnormal curvature towards left and appear like Alphabet C,it is called Levoscoliosis. Levoscoliosis is more common in Lumbar spine.the rare occurrence of levoscoliosis in thoracic spine may prompt the treating doctor to prescribe an MRI to ascertain presence of a spinal cord tumor.
when the abnormal curvature is towards left like reverse Alphabet C it is called Dextroscoliosis.
Dextroscoliosis usually spans from the lower thoracic to upper lumbar vertebrae.
Sometimes the curve could also be in the shape of Alphabet S,this type of scoliosis is referred as thoracic dextroscoliosis and lumbar levoscoliosis.
when the abnormal curvature is towards left like reverse Alphabet C it is called Dextroscoliosis.
Dextroscoliosis usually spans from the lower thoracic to upper lumbar vertebrae.
Sometimes the curve could also be in the shape of Alphabet S,this type of scoliosis is referred as thoracic dextroscoliosis and lumbar levoscoliosis.
Scoliosis can be classified as:
Congenital Scoliosis:
is caused by the presence of abnormal spine structure at the time of Birth.According to Dr Robert Winter at Minnesota spine center,Minneapolis,USA,a founder and past president of Scoliosis research society,the most common of the congenital Scoliosis is hemivertebra that is formation of partial vertebra in a newborn child. Another type of congenital scoliosis is called a Unilateral Bar where 3-4 vertebra are fused together on one side. Congenital Scoliosis is more common in girl child as compared to boys.According to Dr Robert Winter,the congenital Scoliosis are generally not observed at the time of birth unless the child is born with an apparent anomaly or visible deformity,it is accidently diagnosed as if an X Ray of the newborn is taken due to some other sickness ,for example Pneumonia.Treatment for congenital scoliosis is generally a corrective surgery. A right corrective surgery at the right time improves the treatment outcome for congenital scoliosis.Sometime this surgery is followed by another surgery to further increase the treatment outcome. Dr Robert Winter advises parents who suspect a Congenital Scoliosis to look for a possible rib hump or a small bump on the back,the child may also have foot problems like a club foot,the child may have a hairy patch along the spine. If any of these signs appear in a newborn ,parents immediately need to consult a scoliosis specialist.
Functional Scoliosis:
Functional scoliosis is a scoliosis where spine is generally normal but the curve in spine occurs due to any problem in some other part of muskuloskeletal system,Like one leg being shorter than other or by persisting muscle spasm in back. Treatment depends on the cause and affected organ causing it.
Neuromuscular scoliosis:
Neuromuscular Scoliosis is a condition caused by malformation of bones of spine,Muscular dystrophy,cerebral palsy,people with spina bifida and Marfan Syndrome ( a genetic connective tissue disease).This type of scoliosis is usually more severe and need more aggressive treatment.
Degenerative Scoliosis:
Degenerative Scoliosis is more common in elderly people.Arthritis,which causes spondylosis is one of the major causes of degenerative scoliosis The other reasons for Degenerative Scoliosis are wear and tear to spine because of common ageing problems osteoporosis,a trauma ( because of injury or illness), bone collapse or any previous major back surgery.
Degenerative scoliosis may cause stiffness in mid to lower back, pain in lower back and legs,numbness and weakness in legs and feet. Degenerative Scoliosis may also be because of vertebral compression fractures and disc degeneration.
Other Causes of scoliosis may include a benign spinal tumor called Osteoid Osteoma. The pain caused by Osteoid Osteoma may make the sufferer to bend on one side to avoid pain and can cause postural deformity.
what causes Scoliosis?
In majority of the cases the cause are not known and that is why it is called idiopathic scoliosis.But Congenital deformity,cerebral palsy,muscular dystrophy,osteoporosis,arthritis,trauma or injury,neurofibromatosis,Marfan syndrome,Rett syndrome,disc degeneration and ageing may be the major causes of Scoliosis.
What are signs and symptoms of scoliosis?
The most common symptom of scoliosis is an abnormal sideways (Lateral) curve of spine.The symptoms are very sublime in the beginning but gets noticeable with advancement in curvature of the spine. The affected person may feel that there clothes do not fit them as they used to previously or the pant legs are longer on one side.Scoliosis may cause head to appear off center and one shoulder or hip appear to be higher than the other side.The severe cases may cause difficulty for lungs or heart to function properly.,culminating in shortness of breath or chest pain.
It is difficult to predict Scoliosis without an X-Ray but a treating doctor suspecting the patient to have scoliosis may ask the patient to bend forward from the waist as if touching the toe,the position is called Adam's forward bend test and the doctor will look for following signs.
- If one shoulder is higher than the other.
- A shoulder blade protrude more than the other.
- One side of the rib cage appear higher than the other.
- One hip appear higher or protruding more than the other.
- Body tilts to one side.
- Waist appears uneven.
- One leg may appear shorter than the other.
Not all back pain are associated with scoliosis.
Who are at risk of developing Scoliosis?
Age is one of the risk factors,as symptoms for idiopathic or child scoliosis start appearing between the age of 9 to 15 years.Girls are more prone to be affected than the boys. A genetic history is also considered to be one of the causes.
Earlier it was thought that scoliosis was only a childhood condition but now there are increasing evidences of elderly people getting affected. Arthritis and osteoporosis also increases the risk of Scoliosis in elderly patients.
How Scoliosis is diagnosed?
Scoliosis is diagnosed with physical examination by the treating doctor and is confirmed with diagnostic imaging techniques like,X-ray,CT-Scan and MRI.
What are treatments for Scoliosis?
The treatment options depends on the severity of the condition.For Congenital Scoliosis usually treatment is not required if it does not become noticeable and severe,Braces does not work for congenital scoliosis.Surgery is the only viable treatment option for congenital scoliosis.
For Idiopathic scoliosis ,which is more common in children the treatment involve Observation,Casting,Bracing and corrective surgery as the last resort if everything failed and scoliosis is getting severe and abnormal spine curvature is more than 40%.
Correct surgery at correct time is important for treatment outcome of child scoliosis.
For degenerative Scoliosis,which is more common in elderly adults,the treatment options may vary from conservative pain management to steroid injections in medical supervision.In severe conditions which may be painful and debilitating,spinal fusion surgery is done by a spine or neurosurgeon to correct the curvature and giving room to nerve for mobility and reducing pain.
The Scoliosis Surgery for adults may involve two types depending on curvature and severity.
Decompression Surgery:
If pressure is exerted on nerve by the protruding bone or disc, decompression surgery is done for excising the protruding portion to give more room to nerve and reduce pressure on nerve.
Spinal Fusion Surgery:
Spinal fusion surgery involves correcting the curvature to as close as possible,it involves using Metal rods,screws and plates called as implants to hold the spine in place and bone grafts are placed between bones ,which grow with surrounding bones and holds the spine in place called as fusion. Implants are used to support the spine till bone fusion takes place and bone grafts become rigid and keep the spine in place.
These implants are usually not removed and remain inside unless they cause irritation to surrounding tissues.
Patient is usually advised physiotherapy after the surgery to give strength to muscles.
There are two approaches to scoliosis correction surgery.A posterior approach (from the back of the spine) and anterior approach (from the front of the spine), A spine surgeon decides which approach to take depending on the type and location of the curve in spine.
Minimal invasive surgeries with neuromonitoring is used for better treatment outcome and quicker recovery period.
Post Spine surgery care and Management:
Surgeon advises physiotherapy post the spine surgery for gaining strength in muscles.Antibiotics are prescribed to reduce chances of infection and pain relieving medicines are given to reduce any pain or discomfort. Patient is advised to avoid forward or backward bending as it carries the risk of dislocation of the implants till bone fusion takes place.
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Patient need to scan and e-mail the X-ray films and reports,CT-Scans and MRI films and reports to us with a brief medical history with co morbid factors like history of diabetes and hypertension, along with present and past medication to give a correct picture to treating doctor for deciding the treatment course and cost of the procedure,hospital and india stay required and expected treatment outcome even before the patient start from his country for India.
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