Scoliosis�is a curving of the spine from normal position away from the middle or sideways.

Causes

• Congenital scoliosis�is due to a problem with the formation of the spine bones or fused ribs during development in the womb
• Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida and polio
• Idiopathic scoliosis is scoliosis of unknown cause. It appears in a previously straight spine

Idiopathic scoliosis in adolescents is the most common type. Some people may be prone to curving of the spine. Girls, seem to be most affected. Curves generally worsen during growth spurts. Scoliosis in infants and young children are rare and commonly can affect both boys and girls equally.

Scoliosis may be suspected when one shoulder appears to be higher than the other or the pelvis appears to be tilted. Untrained observers usually can't notice the curving.

Middle and junior high schools now have a routine scoliosis screening being done. It has been noticed that many cases, which previously would have gone undetected until they were more advanced, are now being identified at an early stage.

Sitting or standing for a long time can cause fatigue in the spine. Pain will become persistent if irritation results. The greater the initial curve of the spine, more are the chances of the scoliosis getting worse after growth is complete. Breathing problems can occur in cases of severe scoliosis, where the curves in the spine are greater than 100 degrees.

Symptoms

• Backache or low-back pain
• Fatigue
• Shoulders or hips appear uneven
• Spine curves abnormally to the side (laterally)

There would be certain tests and physical examination done which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. A�neurological�examination is also undertaken to look for any changes in strength, sensation, or reflexes.

Tests may include:

• Scoliometer measurements (a device for measuring the curvature of the spine)
• Spine x-rays (taken from the front and the side)
• MRI (if there are any neurological changes noted on the exam or if there is something unusual in the x-ray )

The treatment chosen depends on the cause of the scoliosis, size and location of the curve and how much more growing the patient is expected to do. Often in�adolescent idiopathic scoliosis�(less than 20 degrees), patients require no treatment, but need to be checked regularly every 6 months.�

If found that a child who is still growing has curves getting worse (above 25 to 30 degrees), bracing is usually recommended to help slow the progression of the curve. There are various kinds of braces available. The Boston Brace, Wilmington Brace, Milwaukee Brace and Charleston Brace are a few which have names for the centers where they were developed.

Each brace looks and feels different. Many factors, including the specific characteristics of the curve depend on the kind of brace selected and the manner in which it is used. The patient and health care provider will decide on the exact brace to be used.

The brace that is used, does not reverse the curve. It simply uses pressure to help straighten the spine. The back brace can be adjusted as the patient grows. A back brace does not work in congenital or neuromuscular scoliosis. It is also less effective in infantile and juvenile idiopathic scoliosis.

Surgery would be required for curves of 40 degrees or greater since curves this large would have a high risk of getting worse even after bone growth stops. Surgery involves correcting the curve as much as possible and fusing together the bones in the curve. One or two metal rods are used to hold the bones in position and then locked down with hooks and screws until the bone heals together. Surgery is sometimes done through a cut in the back, on the abdomen or beneath the ribs. In order to stabilize the spine after surgery a back brace may be used.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.

The other Orthopedic Procedures are:

• Achilles Tendon Repair
  
• Hip Replacement
  
• Knee Joint Replacement
  
• Disc Hernia�
  
• Elbow Replacement�� etc

Few Major Hospitals for Deformity Correction are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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