Early Intervention: The Key to Managing Pediatric Spinal Deformities
"Awareness is key in treating pediatric spinal deformities. The earlier we identify and address these issues, the better the outcomes for the child," emphasizes Dr. K. Appaji Krishnan, Senior Consultant – Spine Surgery at Apollo Cancer Centres, Chennai.
Dr. Krishnan's insights are drawn not just from decades of medical practice, but also from personal experiences with his young patients. He recalls a poignant case of a girl from Sri Lanka, whose spine was severely deformed even before birth. Despite her parents' numerous consultations and the discouragement from local surgeons to delay surgery until she was older, the child continued to live her life without complaint, running, playing, and laughing with a spine that was almost bent at a 155-degree angle. This lack of awareness and timely intervention highlighted the critical need for early detection and treatment in managing pediatric spinal deformities.
The most common spinal deformities in children include scoliosis, kyphosis, and lordosis. Scoliosis is a spinal deformity where the spine curves sideways in a "C" or "S" shape, rather than running straight. This condition can vary in severity and may progress as children grow. Kyphosis, on the other hand, is characterized by an excessive forward rounding of the back, often described as a humpback. This condition can also range from mild to severe and can cause significant physical discomfort and aesthetic concerns. Lordosis involves an exaggerated inward curve of the lower back, creating a pronounced arch. While it is a normal feature of the lumbar spine, excessive lordosis can cause discomfort and affect mobility. While many spinal deformities in children are idiopathic, meaning their cause is unknown, others may be congenital, neuromuscular, or related to infections such as tuberculosis. In India, post-infectious deformities, especially due to tuberculosis, are notably prevalent.
Parents might not always recognize the signs of a spinal deformity since children typically do not experience pain. It is often the teachers, parents, or friends who first notice asymmetries, such as uneven shoulders or a noticeable hump on the back. This lack of symptoms makes early diagnosis and intervention all the more crucial. The key indicators to watch for are changes in posture, the appearance of a hump, or an imbalance in the child’s stance or gait.
Diagnostic tools for assessing these deformities primarily include full-length X-rays, MRI scans, and CT scans. X-rays from head to hips help in evaluating the extent and nature of the deformity, while MRIs are crucial for detecting any neurological implications. CT scans provide detailed views of the vertebral bodies, which is essential in congenital scoliosis cases where vertebrae may be malformed.
To determine the severity of a deformity, the angles of spinal curvature have to be measured. Angles greater than 25 degrees are generally considered significant. For curves between 25 and 45 degrees, non-surgical treatments like bracing and specific exercises, such as those prescribed by the Schroth method (a physical therapy approach to scoliosis treatment based on exercises tailored to each patient’s spine curvature), are recommended. Beyond 45 degrees, surgical intervention becomes necessary to prevent progression and alleviate any severe deformities.
Surgical options vary based on the child’s growth stage and the severity of the deformity. For children who are still growing, procedures such as growth modulation or vertebral body tethering (VBT) are preferred. These techniques allow the spine to be corrected while still accommodating growth, thus avoiding the rigidity and potential height loss associated with traditional spinal fusion surgeries. For those who have completed their growth spurt, fusion surgery is performed to straighten the spine using rods and screws.
Recovery from such surgeries is generally swift, with children often resuming normal activities within weeks, albeit with some restrictions on heavy lifting and contact sports for up to nine months. The use of advanced technologies like 3D printing and intraoperative neuro-monitoring has significantly reduced the risks of complications, making these surgeries safer and more precise.
Methods of treatment have witnessed significant advancements over the years. 3D printing technology has had a transformative impact in pre-surgical planning, allowing for customized implants and guides tailored to each child’s unique spinal anatomy. The implementation of real-time neuro-monitoring during surgery has further minimized the risk of neurological damage, enhancing the safety of spinal surgeries.
There are countless children whose lives have been profoundly changed by timely intervention. Currently, awareness is created through initiatives like the Scoliosis Awareness Month and the Scoliosis Screening Program in Tamil Nadu, which have significantly increased early detection rates.
Ultimately, it all comes down to early detection and comprehensive care. "Awareness and timely intervention can prevent severe deformities and ensure children lead normal, active lives," Dr Krishnan asserts.
