Human spine is a vertical column of 33 bones that are placed one upon other with disc in between the two bones. These 33 bones are called vertebra. The spine which is commonly called the backbone provides support to the body and allows the body to stand, bend, twist and turn. It also protects the vital spinal cord. When viewed from the side, the spine is S shaped curve. This helps it to absorb any stress during movement. From the back, spine appears straight.
Certain conditions in children can deform the spine.This deformity can develop as a consequence of malformation of spine in the womb, muscular diseases or traumatic injury. The deformity progressively increases as the child grows causing impairment in breathing due to pulling of ribs and functioning of nerve and heart.
The most common pediatric spinal deformities are scoliosis, kyphosis, spondylolysis. In scoliosis, the spine is curved to one side. In kyphosis, the spine is curved more in forward direction. Kyphosis is also called as hunchback deformity. Treatment of pediatric spinal deformities depends on the severity of the deformity that interferes with normal growth of the child.Treatment can be conservative with spinal casts and braces. Sometimes a corrective surgery may be necessary.
What Causes Pediatric Spinal Deformities?
Pediatric spinal deformities can occur congenitally or may develop after birth. The most common are scoliosis, kyphosis, and spondylolysis. There are number of factors that may cause deformity of spinal curvature. Congenital deformity may develop as a result of improper development of vertebra during the fetal stage. Abnormal spinal structure also develops as a result of traumatic injury while playing sports, or with spinal tumor.
Some causes of spinal deformity are unknown. This are termed as idiopathic scoliosis or kyphosis. At least 65 percent of scoliosis are idiopathic. 15 percent is congenital scoliosis and the remaining are caused due to diseases of muscles and nerves such as muscular dystrophy, cerebral palsy etc.
An injury to the spine can lead to spondylolysis. It can be one of the causes for back pain in children. Kyphosis is often caused due to bad posture or abnormality of vertebra. Infection such as tuberculosis of spine can also lead to kyphosis.
Signs And Symptoms Of Pediatric Spinal Deformities
There are several types of spinal deformities. Each may present with different set of symptoms. Some of the symptoms are common for all these types. The symptoms may develop soon after birth or are gradual in onset. As the child grows and becomes adolescent the symptoms become more prominent and obvious. Symptoms are as follows:
- Asymmetrical shoulder height. This means one shoulder may be up while one side of shoulder is tilted down.
- The head is not in the center. It may deviate to one side.
- The muscles on the back that are attached to the spine are unevenly distributed.
- In females the breasts are uneven.
- Pelvis is tilted.
- Abnormal shape of rib cage. Since the ribs are pulled on one side, person may experience difficulty in breathing.
- Difficulty in walking due to abnormal curvature of the spine.
- Hunched back in case of kyphosis.
- Frequent pain in back.
Treatment Options For Pediatric Spinal Deformities
Spinal deformity of spine in children can be diagnosed with the help of X-ray, MRI or CT scan of spine. PET scan and bone scan helps to detect any malignant or benign tumor of spine.
Treatment for each patient having spinal deformity may have a different approach. Treatment also depends on the severity of the deformed spine and its effect on regular daily life of the child. When the condition is not severe, the pediatric orthopedic surgeon may monitor the child at regular interval.
There are two approaches of treatment. One is conservative and another is surgical correction. Conservative treatment is always tried first. In this type, the child is advised to wear braces. Spinal casts are also used. This will prevent further worsening of the spine curvature as it immobilizes the spine. If braces are effective, there may be no need for spinal surgery. Bracing is the common treatment for scoliosis. A corrective surgery is another alternative method to bring back the curvature to normal from its abnormal shape.