Lifestyle-related ailments are increasingly on the rise since the 1990s. With economic and industrial progress come changes in lifestyle and its obvious consequences – ailments. A striking example is the modern education system and its consequences on children. An emphasis on studying innumerable subjects and covering vast syllabi means children are spending more time sitting over chairs or benches in schools for long periods of time. Further, with most children hooked to devices currently, they are again sitting hunched over devices at home, which compound the problem.
As a result, more and more children are showing less movement and wrong postures resulting in a spurt of skeletomuscular and spinal deformities from a young age. The problem is a lot more common than previously estimated. In the US alone, six million children and in the UK, 2 to 3% of children between 10 and 16 years of age suffer from spinal deformities. Early screening and intervention can correct or overcome the consequences of these deformities.
Composition of the spine
The spine is a complex and sophisticated region of the human body. It’s made of a chain of bones called vertebrae. Flat, inter-vertebral discs separate one vertebra from another thereby preventing collision between them. Nerves and nerve endings emerge from and run all along the spine and around it. Finally, several ligaments, tendons and soft tissue surround the spinal column which provide support and facilitate easy and flexible movement of the spine.
When seen from the side, the spine should show a slight curvature, which is healthy and is indicative of its flexibility and efficient transmission of body weight. When seen from the back, the spine should appear like a straight line from the neck downwards to the lower back. In some children however, the curvature becomes more prominent leading to spinal deformity. The curvature can be side-to-side or three dimensional.
Deformities of the spine
The 3 prominent deformities are:
• Lordosis: Also called swayback, in this case, the spine of a person curves inward at the lower back more than normal
• Kyphosis: In this type, the person shows an abnormally rounded upper back, with the curvature being as severe as 50 degrees in some cases
• Scoliosis: In this type, the person shows a sideways curvature of the spine, which can either be S-shaped or C-shaped.
These conditions can be congenital: present since birth, adolescent: developed during early teenage, or idiopathic: of unknown cause . It is possible to manage spinal deformities successfully.
The causes for developing spinal deformities are wide-ranging. An accident or spinal injury in childhood, childhood obesity, wrong posture such as slouching, and genetic factors or a family member having the ailment are all possible causes. Conditions such as Scheuermann’s disease, Arthritis, Osteoporosis, Discitis, Achondroplasia and Spondylolisthesis are significant risk factors for spinal deformities. Spinal conditions such as spina bifida, a birth defect, spinal infections and spinal tumours are also possible causes.
Symptoms and consequences
The patient may show or suffer from any of the below:
• Head is not centred with the rest of the body
• Uneven waistline
• Uneven shoulder heights
• Hunched back
• Back pain
• Tilted pelvis
• Walking difficulties
• Breathing difficulties
In addition to the physical symptoms, the psychological burden of these deformities can be considerable. Children with these deformities may suffer from poor self-image; depression and anxiety, requiring constant care, monitoring and professional help as well.
Parents and teachers are always the first to notice the signs of these deformities. The way the child sits or walks, is a clear indication of the problem. Parents should not dismiss the issue and must consult a pediatric orthopaedic specialist at the earliest.
The specialist will arrange one or more of these to know the severity of the problem: X-rays, EOS imaging, MRI scan,, CT scan, Bone scan or DEXA scan, Positron emission tomography (PET) scan, Ultrasound, Pulmonary function tests, and Blood tests.
Non-surgical interventions: These include back braces, halo vests and an assortment of bracing devices as the first remedy. These devices immobilize the child’s spine in an attempt to stop progression of the spinal curve and also control the pain. Bracing is a quite successful and time-tested intervention. It can help delay and in some cases avoid the need for surgical interventions.
Surgical interventions: These factor in the growth and skeletal maturity of the child and are longer-term procedures.
These are aimed at permanently stabilizing the spine.
• Spinal Fusion: Here, the bones in the back are joined with pieces of bone taken from the hip or pelvis. Then, metal rods are inserted to hold the spinal column while the grafting heals.
• Growing rods: Two, expandable metal rods are inserted below the spine, one above and one below the curve. Every six months, the rods are expanded using magnets, at a clinic
• VEPTR: In growing children, the spinal curve may squeeze the ribs and affect development of the lungs. The lungs may not get enough air. In this procedure, vertical expanding prosthetic titanium ribs (VEPTR) are inserted inside the rib cage to help the lungs grow normally.