Crooked Back

Dr. Prem Pillay, Singapore

Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology

(Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA)

Having a Crooked Back: What are the Solutions

Dr. Prem Pillay, a Spine Specialist states that everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. Some people have spines that also curve from side to side. Unlike poor posture, these curves cannot be corrected simply by learning to stand up straight.

This condition of side-to-side spinal curves is called scoliosis. On an x-ray, the spine of an individual with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven. If the curve is from back to front, or bent forwards it is called a Kyphosis.

Who gets a crooked back?

Dr. Prem states that Scoliosis affects approximately 2% of the population. If someone in a family has scoliosis(crooked back) , however, the likelihood of an incidence is much higher-approximately 20%. If anyone in your family has curvature of the spine, you should be examined for scoliosis.

Children

Most scoliosis is “idiopathic,” meaning its cause is unknown. It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. Although scoliosis can occur in children with cerebral palsy, muscular dystrophy, spina bifida, and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters. Kyphosis is children can be from spine infections like Tuberculosis (TB) or from spine tumors.

Adults

Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood and was not diagnosed or treated while the person was still growing. What could have started out as a slight or moderate curve may have progressed in the absence of treatment.

Dr. Prem Pillay also states that adult scoliosis can be caused by the degenerative changes of the spine. Other spinal deformities such as kyphosis or round back are associated with the common problem of osteoporosis (bone softening). As more people in the United States and Singapore reach the age of 65 years or older, the incidence of scoliosis and kyphosis is expected to increase. A sudden fall in an older person can result in a spine fracture causing sudden kyphosis, says Dr. Prem. This may require urgent treatment using small needles to introduce a medications to repair the spine fracture. This can be done without open surgery as a day procedure.

If allowed to progress, severe instances of adult scoliosis and kyphosis can lead to chronic severe back pain, deformity and difficulty in breathing. This may require spine surgery to correct and to prevent nerve damage.

The Importance of Early Detection: Tips For Parents

Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years. Therefore, parents should watch for the following warning signs of scoliosis when their child is about 8 years of age:

• Uneven shoulders.

• Prominent shoulder blade or shoulder blades.

• Uneven waist.

• Elevated hips.

• Leaning to one side.

  
  

Any one of these signs warrants an examination by a Spine specialist, states Dr. Prem.

Some schools sponsor scoliosis screenings. Although only a physician can accurately diagnose scoliosis, school screenings can help alert parents to the presence of the warning signs in their child.

Treatment

In planning treatment for each child, Dr. Prem Pillay states that, as a Spine expert he will carefully consider a variety of factors, including the history of scoliosis in the family, the age of the child when the curve began and the location and severity of the curve.

Most spine curves in children with scoliosis will remain small and need only to be periodically assessed for any sign of progression. If a curve does progress, a spine brace can be used to prevent it from getting worse. Children undergoing treatment with spine braces can continue to participate in a full range of physical and social activities. Modern spine braces allow more mobility than the older rigid ones and can be custom made and modified as the child grows.

If a scoliotic curve is severe when it is first seen, or if treatment with a spine brace does not control the curve, surgery may be necessary. In these instances, surgery has been found to be a highly effective and safe treatment for scoliosis and massage therapy or manipulations has not been shown to be effective.

Summary

Scoliosis is a common problem that usually requires only observation with repeated examination in the growing years. Early detection is important to make sure the curve does not progress. In the relatively small number of patients who require medical intervention, advances in modern spine techniques have made scoliosis a highly manageable condition.

Kyphosis can occur suddenly in older people with osteoporosis and may need special spine injections and medications to treat effectively, says Dr. Prem Pillay.