What is scoliosis?
The term scoliosis derives from the Greek and indicates a sideways deviation and a permanent deformation of the vertebral column, which cannot be modified voluntarily, which is accompanied by anatomical alterations of the vertebrae and other supporting structures of the trunk.
The vertebral column can be compared to a flexible pile of articulated segments (the vertebrae). Usually, the column remains straight because the overlapping parts have a perfectly regular and symmetrical shape, the articular capsules and ligaments keep them in an exact position, and the muscles provide a well-balanced support force.
In the presence of scoliosis, the column, observed from front and back, instead of being straight, is curved and turned on itself.
Scoliosis vs. scoliosis attitude
For a correct diagnosis it is necessary to make an essential distinction between scoliosis and scoliotic attitude:
- If the column is deformed and cannot be corrected, it is scoliosis, which is a three-dimensional deformity of the vertebral column, characterized by the bending, rotation, and deformation of the individual vertebrae
- If the column has a curve but can be self-correctable, it is a scoliotic attitude
Measurement of scoliosis curves
The extent of scoliosis deviation is expressed in degrees. The measurement system currently most used is that of Cobb – two passing lines are traced for the upper and lower plate of the vertebrae limiting the curve and to these the respective perpendicular. The angle that is formed is called the curvature angle or Cobb angle.
Generally, cases are considered indicative of scoliosis values above 5 degrees Cobb; most scoliosis has curvature angles between 5 and 30 degrees Cobb; if the curve exceeds 30 degrees, there is a very remarkable curve.
From a diagnostic point of view, it is essential to assess whether one is dealing with a patient suffering from structural scoliosis or from a simple scoliotic attitude. The scoliotic patient, or with suspicious scoliosis, must be examined in three positions: in an upright position, flexed forward, lying on a couch in a supine position.
In the few cases of scoliosis (less than 15%) in which results with the orthopedic corset and physiotherapy are not obtained, and the scoliotic curve exceeds 40 degrees, arthrodesis correction is required. Surgery is practiced on children as young as 12-13 years, while in adults the indication is, instead, above all the pain in the back, which heavily affects the quality of life.
- Operation Procedure – Arthrodesis is about four hours long and is very delicate. It is performed under total anesthesia, on the patient’s back, and consists in fixing two titanium bars to the vertebral column, to straighten it, hooking them to screws anchored to the vertebrae. In this way, the rotation of the vertebrae is also canceled, which has determined the hump over the years (asymmetry of the back). During surgery, the marrow function is carefully monitored to immediately recognize any suffering, using the so-called evoked potentials, tests that study the responses of the central nervous system to a sensory and motor stimulus. For this reason, the neurological risk of paralysis, compared to the past, is extremely reduced (less than 1%).
- Rehabilitation – After three days in bed in a supine position, the patient can slowly get up and start walking, without having to apply braces. The pain, at first intense, will gradually disappear. In the first month of convalescence, it is necessary to be at complete rest. It then takes another two months of rehabilitation exercises in the swimming pool, to recover definitively. In the following two years it is advisable to swim and undergo checks every six months. The operation corrects, blocking it, only the part of the column affected by scoliosis, so as not to limit too much the movement of the back. Within a year the scaffolding performs its function, and the column will be permanently straightened. Screws and bars are generally left unless they create discomfort, which happens very rarely.
The treatment to treat scoliosis may range from INR 2 lakhs to 8.5 lakhs or USD 3,000 to 12,000 depending on the extent of the operation. Laparoscopic Kyphoplasty used to remove small lesions that cause distress cost less while full Arthrodesis is at the higher end. Indraprastha Apollo in Delhi and Columbia Asia Hospitals in Kolkata, Bangalore and Gurgaon have excellent spinal surgery facilities.