Monday, June 11, 2012

SURGERY FOR SCOLIOSIS: STANDING ERECT

Scoliosis (from Ancient Greek : σκολίωσις skoliosis "obliquity, bending") is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C", rather than a straight line.

Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at Birth), idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma).

Management of scoliosis ranges form observation to surgical correction depending on the type of scoliosis and its progression. Scoliosis surgery has come a long way with improved understanding of the biomechanics of the spine and better radiological visualisation of the deformitiy. The aim of surgery in scoliosis is to correct the deformity as far as is possible, as early as possible, without compromising neurological function, and to prevent the progression of secondary respiratory problems, that could be fatal or lead to severe morbidity. In essence surgery is to provide for a better quality of life.

CASE EXAMPLE:
17 year old PP was noticed to have a bend in his back from a young age. Though medical opinions were sought no treatment was given, through misguidance, fear and ignorance. The bend kept worsening and eventually he started developing frequent breathing problems and chest infections. Realising that the boy’s condition was getting worse, they eventually consulted Dr K Sridhar. The boy had a significant scoliotic curve with a congenital hemi vertebra (maldeveloped vertebral body). After several counselling sessions, regarding surgical correction of the bend (scoliosis) and the prognosis of surgery, the surgery was performed in 2 stages. In the first stage, the chest wall was opened and the hemi vertebra was excised, creating a wedge decompression. In the second stage the spine was exposed from the back and after placement of screws from the upper thoracic to the lower lumbar levels, the spine was straightened, as much as was safe. Surgery lasted a total of 18 hours. The boy made a remarkable recovery.
At discharge the boy was standing and walking straight, … no longer does he need to live with a bent back!

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