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Spinal deformity is an abnormal alignment or curve of the bony vertebral column.
Spinal deformity is of two types:
The spinal deformity can occur in pediatric as well as in the adult age group.
Pediatric scoliosis or kyphosis is a cosmetic problem that usually progresses as a child grows and can present as deformed back, shoulder asymmetry, chest wall and back asymmetry, waist asymmetry noticed by parents or school teachers. In cases of severe deformity, a child may present with breathing difficulty. Back or neck pain is not the usual presenting symptoms.
Management Outline of pediatric scoliosis:
The general goal is to prevent curve progression and to achieve a balanced spine. The treatment options depend on the size and progression of the curve, age of the patient and the aetiology of scoliosis.
The three O’s
Observation: when curve deformity is less than 25 degrees
Orthotics: when curve deformity is between 25-40 degrees
Operation: when curve deformity is more than 50 degrees
For the curve, less than 25° in an immature child, 6 monthly or yearly Observation is recommended.
Orthotic (braces) is recommended for immature patients with progressive curves between 25-50°. Bracing, however, does not permanently improve or correct the curve but tries to prevent it from worsening.
Operation: Curve >45-50° requires surgical correction and the type of surgical correction depends on the age of the patient. Instrumented correction and fusion surgery is the gold standard of treatment for adolescent scoliosis while in early-onset scoliosis (age <8-years) surgical correction requires growth rod or growth guidance techniques. Not all children with scoliosis require surgical correction. Moreover, complete correction of the deformity is not necessary and sometimes risky too. In fact the aim of surgery is to stop progression and obtain a balanced spine.
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