By the kind courtesy of the specialists at Foundation of Orthopedics and Complex Spine (FOCOS) Hospital, which specializes in complex spine and joint replacement surgeries, ghanabusinessnews.com brings you this educative article on spinal deformities.
The normal spine has natural curves which help to absorb loads applied to it from the weight of the body. When viewed from the side the cervical (neck region) and lumbar (lower back) regions have curves with concavities pointed away from the face. This is known as Lordosis. The thoracic spine (upper back) and sacrum have their concavities pointing towards the face when viewed from the side. This type of curve is called a Kyphosis.
In the normal person, the spine is straight when viewed from the back.
The Sagittal plane (vertical plane passing longitudinally through the body) divides the body into right and left. The frontal (coronal) plane divides the body into front and back.
There are three basic types of spinal deformity: Scoliosis, Kyphosis and Lordosis. They may occur singularly or in combination. Scoliosis occurs in the coronal plane. Kyphosis and lordosis occur in the sagittal plane
Scoliosis is a lateral (side to side) bending of the spine. Kyphosis is an abnormal forward bending of the spine. Lordosis is an abnormal inward bending of the spine. These abnormal curvatures can occur anywhere in the spine. However the thoracic and lumbar regions are the commonest sites for spine deformities. Spinal deformities are also often associated with abnormal rotations of the spine about its longitudinal axis.
Spinal deformities are classified according to their location (e.g. thoracic), direction (right scoliosis), angular magnitude (e.g. 60°) and cause (aetiology).
Aetiologically the causes of scoliosis include:
- Idiopathic Scoliosis. This is the most common of all forms of lateral deviation of the spine. It occurs in an otherwise healthy child. A recognizable cause has not yet been found. Tends to affect females more than males.
It is classified according to age of onset into Infantile (0-3 years), Juvenile (3-10 years) or Adolescent (greater than 10 years).
- Neuromuscular scoliosis is caused by disorders of the brain, spinal cord and muscular system e.g. Cerebral Palsy, Poliomyelitis, Spinal Cord Tumour, and Spinal Cord Trauma. These lead to inappropriate balance or alignment of the spine and trunk. Most of the curves have onset in childhood and tend to worsen with growth.
- Congenital Scoliosis. This results from abnormal development of the spine. This may be defects of segmentation or defects of formation. The result is an imbalance in the longitudinal growth of the spine. A curvature appearing within the first few months of life is not necessarily congenital as it may be an infantile idiopathic scoliosis. Similarly, though the vertebral anomalies may be present at birth, the spine deformity may become apparent only later in childhood.
Other aetiological causes of scoliosis are Neurofibromatosis, connective tissue disorders, Trauma, and Infection of the spine including Tuberculosis, Tumours and metabolic bone disease.
The causes of Kyphosis include
-Congenital vertebral anomalies
-Post spinal infection e.g. from Tuberculosis of the spine
-Post surgery e.g., post laminectomy, post vertebral body resection
The etiologic causes of Lordosis include
-Congenital vertebral Abnormalities
Spine deformity in Ghana
The incidence and prevalence of spine deformity in Ghana are unknown. In general, idiopathic scoliosis is known to have 2 to 3 per cent prevalence in the general population worldwide.
Genetics does play a role in Spinal deformities. Some causes of Scoliosis have underlying genetic disorders e.g. Spinal Muscular atrophy which causes Neuromuscular Scoliosis is an autosomal recessive disorder; Neurofibromatosis is inherited in an autosomal dominant manner. Having a close relative (parent, sibling) with Adolescent Idiopathic Scoliosis increases a child’s risk of developing the condition
Large spinal deformities are usually obvious. Other features which may accompany spine deformities include asymmetry in the shoulders, scapulae and waist lines, protuberant ribs, abnormal gait, anterior (frontal) chest wall deformities. Limb abnormalities including weakness and exaggerated reflexes may be present.
Physical examinations will seek to rule out any underlying cause of the deformity. Café au lait spots, subcutaneous nodules in the axillae and inguinal regions may suggest neurofibromatosis as a cause.
The presence of joint contractures, impaired mental function may point to cerebral palsy. Excessive flexibility of extremities may be an indication for underlying marfan’s syndrome.
A good history is important in determining the possible etiologic cause of disease, curve progression and the effect of the deformity on the patient.
Spine deformities are confirmed by X-Rays. CT scans and MRI scans may be needed in further management of the patient
When not treated
Spine deformity untreated may lead to.
- Decrease in chest wall cavity, restrictive lung disease with impaired lung function and sometimes death. This is especially so in patients with severe lordotic thoracic curves and infantile and juvenile scoliosis.
- Neurological deficits including limb weakness, loss of bowel or bladder function, loss of sensation, gait abnormality.
- Loss of self-image
- Progressive deformity
There are several treatment modalities for spine deformities. These include conservative treatment, physiotherapy, Bracing, Casting and Surgery.
Early detection and treatment usually yields good results.
For patients who are indicated for surgery, the risks of surgery among others is directly related to the curve magnitude, complexity of surgery and Pulmonary function
It is therefore important that patients with spine deformities seek early medical attention.
By Dr Kwadwo Poku Yankey – Specialist
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