Scoliosis and Other Spinal Deformities
Good posture, physical fitness and attention to ergonomics are indispensable to orthopaedic health. However, some people are challenged by spinal deformities that interfere with the body's erect carriage.
The following terms describe three general types of spinal deformities that may be found in children.
What Causes Spinal Deformities?
Spinal deformities may be caused by congenital spine problems, neuromuscular disorders, genetic tendencies and other factors. In many cases, the deformities are idiopathic, meaning they are of indeterminate origin. About 80 percent of all cases of scoliosis are idiopathic. For some reason, girls with scoliosis are more likely to develop a higher degree of curvature.
How are Spinal Deformities Diagnosed?
Many schools routinely screen their students for scoliosis using the well-known Adam's Forward Bending Test, in which a child bends forward at the waist with the arms hanging down. In this position, asymmetries of the child's back are easily viewed and palpated by the examiner.
Your child's physician may also perform the Adam's Forward Bending Test along with other physical examinations to see what kind of asymmetries may be present. Neurological examinations and X-rays may also be performed.
What if My Child Needs Surgery?
Most spinal curvatures can be controlled using non-surgical means. If, however, the curve continues to progress in spite of treatment, surgery will be necessary to prevent significant orthopaedic impairment and damage to internal organs.
The surgical re-alignment of vertebrae may be accomplished via spinal instrumentation (the implanting of hardware such as rods, hooks, and screws) and/or spinal fusion (the implanting of bone grafts between vertebrae). For younger children, spinal instrumentation alone is sometimes recommended. For adolescents and adults, a combination of spinal fusion and spinal instrumentation may be required for best results.
Surgical Innovations in Spinal Instrumentation
Until recently, spinal instrumentation usually called for an orthopaedic surgeon to implant a rigid rod close to the spine attached by a series of hooks and wires. This technique has proven itself to be fairly effective, although there is a small chance of hook dislodgement, vertebral fracture and irritation to the soft tissue surrounding the spine.
Fortunately, better results are being obtained from a newer technique for spinal instrumentation called pedicle screw fixation. In this technique, the vertebrae are fitted with small screws instead of hooks. The screws allow for a better grasp of the vertebrae, a higher degree of scoliosis curve correction and a reduced likelihood of vertebral fracture. Moreover, preliminary follow-up on patients who have had this procedure indicate that the screws may be less irritating to the soft tissue than the hook-and-rod system.
Pedicle screw fixation is a technically demanding operation, particularly when performed on the thoracic vertebrae. Such a delicate procedure should only be performed by surgeons who have undergone rigorous training. One of the surgeons in our practice, Michael Jofe, MD, is an expert on the theory and practice of pedicle screw fixation and will gladly answer any questions you have about the safety and efficacy of this procedure. In May of 2006, he appeared at the annual meeting of the Pediatric Orthopaedic Society of North America to present his findings on "Superior Correction of Adolescent Idiopathic Scoliosis by Thoracic Pedicle Screws."
To learn more about pediatric orthopaedic conditions, please refer to the following organizations: