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Scoliosis - Best Neurosurgeon and Neurologist in Bangalore | Dr.Venugopal

Scoliosis

Viewed from the front or back, the spinal column should be straight. When scoliosis is present, you will see a sideways shift of the spine to the right or left. Approximately ten percent of the population has small curves (less than ten degrees), which are of no consequence to function or health. This condition is called Spinal Asymmetry.

When a diagnostic x-ray is done, the curve of the spine is measured in degrees, as an angle, and this is called a Cobb angle. Scoliosis is defined as a curve greater than ten degrees. It is most common in the thoracic and lumbar regions of the spine and can involve one or both of these regions. The most common curve pattern is a right thoracic curve.

There are naturally occurring curves in the spinal column when it is viewed from the side (laterally). Swayback (lordosis) is normally present in the cervical and lumbar regions while round back (kyphosis) generally exists in the thoracic spine.

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Scoliosis can arise from a number of underlying conditions, but the most common form is idiopathic, which means “cause unknown.”

Scientists have identified that idiopathic scoliosis is a genetic condition and continue to work to isolate the combination of individual genes that cause scoliosis. A test has been developed that may help determine the risk of progression of scoliosis (whether or not the curve will get bigger). This may eventually allow for earlier diagnosis and more accurate selection of the “best” treatment for each patient.

There is some evidence to suggest that uneven growth rates between the anterior (front) portion of the vertebrae and posterior (back) portion of the vertebrae may be one cause of scoliosis.

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Idiopathic scoliosis is thought to be present in two-to-three percent of adolescents. One in five hundred of these will require active treatment and only one in five thousand have curves that progress to the degree where surgery is recommended. Girls and boys are equally affected by small degrees of scoliosis. Girls, however, are eight times more likely than boys to develop progressive curves.

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Scoliosis can be treated non-operatively or operatively, depending on how large the curve is. Non-operative treatment entails observation, which means a scoliosis specialist periodically checks the curve for signs of progression and the patient may or may not be asked to wear a brace.

Operative treatment (surgery) may be considered if the curve is significant and will likely continue to progress after growth is finished.

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This partially depends on the stage of growth, the location and severity of the curve(s), the curve pattern, and the surgeon’s preference. In general:

  • When a curve reaches forty-five to fifty degrees, surgery may be recommended even though growth is not complete.
  • At skeletal maturity (the end of growth), curves measuring less than forty degrees tend not to progress. However, lumbar curves less than forty degrees might progress.
  • At skeletal maturity, some curves between forty to fifty degrees progress and some do not. Treatment recommendations vary.
  • At skeletal maturity, curves measuring greater than fifty degrees are at greater risk for continued progression throughout adulthood, although at a slower rate (i.e., approximately one to two degrees per year). As a result, surgery will likely be recommended.
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This partially depends on the stage of growth, the location and severity of the curve(s), the curve pattern, and the surgeon’s preference. In general:

During surgery, the curve is corrected as much as is safely possible. To do that, implants (generally rods, screws, wires, and/or hooks) are attached to the vertebrae at the section of the spine that is curved. After correction is achieved, bone graft is placed over the implants. With time, this bone graft fuses (or grows together) with the existing bone and forms a solid column of bone in that area. The implants act as an internal brace to hold the spine in the corrected position while the bones are fusing. This generally takes six to twelve months. The fusion of the bones takes away the growth potential in that part of the spine, which is what has caused the scoliosis to worsen.

Individual vertebrae grow approximately one millimeter per year, and potential height lost is generally balanced by the amount of height gained with correction of the curve(s). The fusion also permanently stops the motion of the spine in the segments that are fused. The loss of flexibility is modest and limits function of the trunk very little.

Individual vertebrae grow approximately one millimeter per year, and potential height lost is generally balanced by the amount of height gained with correction of the curve(s). The fusion also permanently stops the motion of the spine in the segments that are fused. The loss of flexibility is modest and limits function of the trunk very little.

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