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Adolescent Idiopathic Scoliosis Lenke Type 2


Scoliosis: best scoliosis clinic in Pune | back pain treatment in Pune | top spine surgeon in Pune | lower back pain treatment in Pune

Scoliosis is a condition where the spine curves sideways. Everyone's spine is at least a little curved – nobody has a perfectly straight backbone – but an abnormal lateral or sideways curvature of the spine i.e if the angle of the curve measures 10 degrees or more, the patient is said to have scoliosis. Normal Spine, when viewed from the front, forms a straight line. Most of the times it occurs in the adolescent age group and the cause is unknown which is known as Adolescent Idiopathic Scoliosis and the majority of scoliosis occurs in females


Different Types of Scoliosis?

The main types of scoliosis are idiopathic scoliosis, Adolescent Scolisos and adult degenerative scoliosis.

A) What is Idiopathic Scoiosis ?

Idiopathic scoliosis develops in childhood. It can be divided into early-onset idiopathic scoliosis and late-onset idiopathic scoliosis. Early-onset scoliosis occurs between birth and 9 years of age. Generally, the earlier the age of scoliosis onset, the more severe and disabling it may become. Early-onset scoliosis can result in major lung problems due to lack of normal lung development and sometimes can progress rapidly.

B) What is Adolescent idiopathic scoliosis?

Also known as Late-onset scoliosis typically presents between 10 to 17 years of age. Adolescent Scoliosis is more common in females community, and mostly affect the thoracic (upper) spine and rib cage.

The lungs are usually developed by this stage and so lung problems are typically not as severe unless the scoliosis is quite major (over 80 degrees curve).

For children under 14 years who have a large amount of growth left are recommended with immediate treatment will in most cases.

The bracing procedure is recommended for a patient with 25 – 40-degree curves and surgical procedure is often advised if the curve increases to 50 degrees in a growing spine. Whilst this is classified as major surgery, 90%of patients are able to return back to routine activities by around 12 months post the operation.

C) What is Adolescent idiopathic scoliosis?

Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain.

Adult scoliosis can be categorised into two major groups:

  • Adult Idiopathic Scoliosis. Those adult patients who have had scoliosis since childhood or adolescence come under this category. These people ‘bring the curve with them’ from childhood.
  • Degenerative Scoliosis ( Adult “De Novo” ) : This develops in adulthood i.e from age 18. Degenerative scoliosis develops as an outcome of disc and facet joint degeneration. Due to the degeneration of the intervertebral discs, the patient loses height. If anyone side of the disc degenerates faster than the other side, the disc can tilt and this causes the spine to bend and curve.

What are the Causes of Scoliosis ?

In approximately 80% of cases, the cause of scoliosis is unknown due to its Idiopathic nature ( i.e Roughly 8 out of 10 cases are Idiopathic Scoliosis ) . As mentioned above it usually develops when the patient’s age is between 10 and 17 years old, roughly coinciding with the onset of puberty. It is said to be the due diligence of genetic factors, however, research into the exact cause of idiopathic scoliosis is still ongoing.

Scoliosis can also arise as a result of underlying medical conditions such as

a)muscular dystrophy
b)cerebral palsy and
c)Marfan syndrome.

Sometimes, a baby will be born with scoliosis because of the way their spine developed in the womb; conversely, some types of scoliosis don't develop until old age.

What Are the Symptoms of Scoliosis?

Symptoms of Scoliosis can be jotted down in accordance to its type:

A) Scoliosis Symptoms in Kids:

Every child with scoliosis is different. Some don't have any symptoms. Others have very obvious ones, for example :

  • The shoulders are two different heights
  • The head doesn't look centred with the rest of his body
  • One hip is higher than the other or sticks out
  • The ribs are pushed out
  • His arms don't hang down straight next to his body When the child stands straight
  • When the child bends forward, the two sides of his back are different heights

B) Scoliosis Symptoms in Adults:

  • Uneven shoulders and/or hips
  • Bump in the lower back
  • Numbness, weakness, or pain in the legs
  • Find Trouble while walking
  • Difficulty in standing up straight
  • Fatigue or Tiredness without doing much
  • Short breath
  • Short Height than usual
  • Bone Spurs - bumps in the joints of the spine from bone and joint damage
  • Feeling of fullness, even if not had much food. This is because your spine is putting pressure on your belly.
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Treatment For Scoliosis

We recommended the treatment for scoliosis depending upon a number of factors which including:

  • The patient's age
  • The severity of their spinal curve
  • The location of the curve
  • How quickly the curve is progressing (getting worse)
  • Whether or not the patient is still growing or has the growth stoped

A) OBSERVATION:

In children and adolescents patients showing signs of scoliosis, we traditionally recommend many patients to have a “wait and decide” observation period. This is often done during the early period of diagnosis where the curve is not large enough to recommend any non-surgical or surgical treatments such as bracing or surgery. Regular monitoring of the progression of the curve is done by regular examination and radiological studies.

B) Bracing:

Non-surgical treatment to treat Scoliosis comprises of bracing - In this procedure the individual wears an external brace for a recommended period of time (typically ranging from 2-3 years) to try and stop the curve from getting worse. This is most effective in the growing spine i.e but does not play a pint of role in adult scoliosis. Adjustable braces can be used to accommodate the growing spine. Wearing a brace doesn’t cure or reverse the scoliosis curve, however, it usually prevents further curve progression of the curve.

Most braces are made of plastic fibre and are customised to fit the body of the patient. They are difficult to notice and observe underclothes, as they fit very well. Patients are asked to wear Braces day and night, as their effectiveness increases with the number of hours a day they are worn. Children wearing braces usually can participate in most activities with minimal restrictions and limitations. They can take off the brace for short periods of time if they wish to to participate in any sports event. The patients are asked to wear the Braces until the bones stop growing. This is usually recommended when :

  • Around two years after the onset of menstruation
  • At the time when teenage boys need to shave daily
  • When their height plateaus and they are no longer getting taller

C) Injection and Radiofrequency Non-Surgical Treatment For Reducing Pain

  • Patients with back and leg pain may get some benefit from injection treatment to help relieve from the suffering from pain. Radiofrequency treatment may also be of some assistance.
  • These treatments are aimed to reduce pain and are not used to t change the shape of the spine or treat the curve of the spine

D) PHYSIOTHERAPY

Physiotherapy is recommended to the patients sometimes, however, there is very little evidence that physiotherapy can make a long term difference to curve progression or helps in avoiding the need for the surgery. Physiotherapy are found to be helpful in pain management of spinal disorders.

E) SPINAL SURGERY

Surgery is recommended only in individuals with a severe curve which may affect other vital functions of the body or those with a high progression rate and surgery cannot wait till the skeletal maturity is reached. Surgery for scoliosis aims at rectifying the curve with metal rods, screws and hooks to stabilize the spine. An open or minimally invasive approach can be used for surgery.

It involves correcting the spine shape and fusing it for stabilisation of it’s corrected position. it involves the use of a variety of elements which includes screws, hooks, rods, and sometimes wires. Surgery may be done commonly from the back or the front of the spine, and sometimes a combination of both. In the childer, there are multiple surgical techniques for holding the spine straight, allowing control and maintaining spine growth as much as possible.

Adults spinal surgery: In Adults, spine is combined with the stabilizers to treat the wear and tear which has been accumulated over the years which makes the spine joints stiffer. The patients usually complain of back pain due to the compression on the spinal cord or nerves