Scoliosis In Cerebral Palsy

How to overcome a curved spine

London - Princess Eugenie, 21, recently talked of the operation she had aged 12 to correct curvature of the spine caused by scoliosis. Dr Ellie Cannon explains this common childhood condition.

What is scoliosis?

Our spines naturally curve from front to back but they should be straight from side to side. Scoliosis occurs when a spine bends to the left or the right. This is different from kyphosis, an exaggerated curve from front to back, making someone appear hunchbacked. Scoliosis affects one in 40 children and usually develops during puberty when there is a major growth spurt. Girls are more at risk of the severe forms. You are more likely to develop it if someone in your family has it.

What causes the condition?

The majority of people who get it have idiopathic scoliosis, meaning that the cause is unknown. Other scoliosis is caused by underlying bone abnormality or a muscular disease such as cerebral palsy or muscular dystrophy, where scoliosis is one symptom. Occasionally people are born with the problem, known as congenital scoliosis. Scoliosis is not related to having poor posture, nor can it be prevented.

How would I know I have scoliosis?

In many cases it is mild enough not to be noticeable unless you are bending down, as it can be painless. In more severe cases it causes pain and disfigurement. The curving of the spine is noticeable either as a bulging of the shoulder blade or a twisting of the pelvis. In Princess Eugenie’s case, it was discovered when she had a massage.

Does scoliosis always require treatment?

In most cases, no. If a child has stopped growing and the scoliosis is mild, they do not need treatment as the spine will not continue to curve and twist. With a more severe curve, patients require treatment - either spinal surgery such as Eugenie had, or wearing a back brace - to prevent it becoming worse.

How does a back brace work?

By stabilising the spine and preventing it from worsening - it does not cure any curvature already present.

Is spinal surgery a cure?

In severe cases, surgery is needed to realign the spine, which is often fixed in position by fusing vertebrae. Rods may be inserted to keep the spine straight.

cerebral palsy » Idiopathic Scoliosis

According to the National Scoliosis Foundation all spines are curved if they are observed from the side, when viewed from the front a normal spine should be straight. However, a small percent of the population have spines deformed enough to warrant treatment.

Scoliosis is a deformity of the spine that causes a noticeable curve when seen from the front, and almost always worsens over time. Your doctor will check for a family history of scoliosis, examine the body externally to check for asymmetry and order x-rays if thought helpful. If the spinal curvature becomes worse over time, the doctor will diagnose scoliosis. Adolescent idiopathic scoliosis is most common type in younger children.

For minor curvatures in children, a doctor may recommend monitoring the condition over time. Mild scoliosis in some children improves without treatment as they reach adolescence.

Scoliosis causes are poorly understood. In the case of the most common form of scoliosis, Adolescent Idiopathic Scoliosis, there is a clear hereditary connection from parent organisms to their offspring; it underlies much of genetics, but not all individuals who have two gene mutations will go on to develop symptoms.

Various causes have been implicated, but none has consensus among scientists as the cause of scoliosis. Scoliosis is more common in females and is often seen in patients with cerebral palsy or spinal bifida, although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic. Scoliosis does not come from slouching, sitting in awkward positions, or sleeping on an old mattress. Scoliosis often presents itself, or worsens, during the adolescence growth spurt.

Adolescent idiopathic scoliosis (AIS) at the present time, is the most common deforming orthopedic condition in young children. This type of spinal curvature is noticeable at or about puberty and is the most aggressive form which leads to progressive spinal curvature and vertebral rotation. In children it is associated with pain, reduced function and poor self-image. In adults it is associated with increased back pain, poor quality of life and disability. Estimates of prevalence of mild curvature, those varying from five to twenty degrees, is thought to be up to 3% of adolescents with a male to female ratio of 1:2. In moderate to severe curves that may require medical management, the prevalence varies between.03 and.09% with a male to female ratio of 1:7.

Surgery of the pediatric spine

Cerebral palsy, principles and management

The Growing Spine, Management of Spinal Disorders in Young Children

Surgical management of spinal deformities

Orthopaedics