Scoliosis and Hyperkyphosis, the importance of early diagnosis from an early age to avoid surgery

Scoliosis is a deformity of the spine

It is caused by rotation and deviation of the vertebrae in both the frontal and sagittal and horizontal planes.

Hyperclyphosis, on the other hand, is an increase in the normal sagittal curve of the spine in its thoracic section, often resulting in a forward imbalance of the patient.

They are generally associated with altered musculoskeletal development in childhood/adolescence, but there is also a form that originates in adulthood as a consequence of degenerative-arthritic processes, the so-called ‘de novo scoliosis’.

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Scoliosis and hyperkiosis at a young age affect about 7-8 % of the population

In most cases they have no known cause (idiopathic form) but there is probably a hereditary predisposition.

More rarely, they may be associated with altered vertebral formation (congenital), neuromuscular disorders or genetic syndromes.

The most common form of idiopathic scoliosis is adolescent scoliosis, i.e. it develops around the age of 10 and can progress until the end of skeletal maturity, which occurs between the ages of 17 and 19.

It is therefore crucial to assess patients in this age group.

In the adult population, on the other hand, a spinal deformity can be the evolution of a juvenile form or be the consequence of common arthritic changes that develop with age.

In fact, it is estimated that around 60 per cent of adults have spinal column problems ranging from ‘simple’ herniated or protruding discs to narrowing of the spinal canal, vertebral instabilities and more or less severe forms of hyperclyphosis and scoliosis.

Scoliosis and hyperclyphosis in the young/adolescent are often asymptomatic

That is, the patient does not experience any back pain or particular discomfort during his or her daily activities, except when the situation has reached a moderate to severe level.

There are, however, some signs that may lead one to suspect the presence of a spinal deformity: asymmetry of the shoulders, shoulder blades and pelvis, difference in limb length, prominence of the ribs and rib cage, asymmetry of the back muscles, presence of an excessive curvature of the back.

The assessment of these abnormalities should be made periodically by the paediatrician/medical practitioner who, if deemed necessary, should refer the young patient to the orthopaedic specialist for further investigation.

In adults, on the other hand, the most common symptom is back pain in the lumbar and/or dorsal region, but other complaints such as leg pain, sciatica and cruralgia, or progressive difficulty in walking and maintaining good balance can often be associated.

It is very important to arrive at the diagnosis as early as possible so as to implement all the useful tools to slow down or stop its evolution.

This can certainly be done by relying on the consultation of a doctor specialised in orthopaedics.

Diagnostic investigations for Scoliosis and Hyperkyphosis

The first-level examination to make a diagnosis of ‘observation of the degree of ossification of the iliac crest.

This affects the duration of patient monitoring or the use of any corrective braces.

Second-level examinations that the specialist may request are: CT scan, useful for assessing any abnormalities in the structure of the vertebrae and the conformation of the vertebral elements; Magnetic Resonance Imaging, which can assess the characteristics of the spinal cord and is useful for investigating the presence of other problems of the spinal column sometimes associated, such as herniations or degeneration of the intervertebral discs, narrowing of the vertebral canal, vertebral collapse and instability, tumours of the spine or nearby tissues.

Conservative treatment

In juvenile forms, for mild scoliotic curves (15-20°), there is no particular treatment to be carried out.

The patient is encouraged to perform physical activity for symmetrical strengthening of the muscles that support the spine, with clinical evaluation every 4-6 months and possible control X-rays at the discretion of the specialist.

For moderate curves, between 20° and 35-40°, treatment involves the use of custom-made orthoses/braces, the type of which depends mainly on the location of the curve.

The combination of corrective gymnastics is indicated to improve the effectiveness of the corset and the elasticity of the spine.

If the scoliotic curve is greater than 35-40° or there is a hypercosis greater than 70°, due to delayed diagnosis or failure of conservative treatment, surgical treatment is often necessary.

Even if the young patient is asymptomatic, there is a very high probability of worsening in adulthood, resulting in disabling symptoms.

In adults, treatment with a corset is not useful as the skeletal maturity achieved would not allow any type of improvement in the deformity.

Instead, reinforcement of the postural muscles is recommended and medical therapies (anti-inflammatory and analgesic drugs or infiltrations) or physical therapy with the use of antalgic currents, magnetotherapy or tecartherapy are often used.

Surgical treatment

The main purpose of surgery is to halt the progression of the deformity and, secondarily, to correct it.

In fact, ‘arthrodesis’ surgery aims to allow bone fusion of the deformed spinal tract after derotation and correction manoeuvres.

In adult forms, surgery is also performed to alleviate the symptoms often associated with the presence of vertebral instability, canal stenosis and herniated discs, if conservative treatments have failed. The goal in this case is to improve the patient’s quality of life.

These are complex surgical procedures, under general anaesthesia, requiring multidisciplinary teamwork, to be performed at specialised spine surgery centres.

Great progress in terms of less invasive surgical techniques, more reliable instruments, and increasingly refined anaesthesiological and neurological monitoring procedures have made it possible to minimise the complications associated with this type of surgery and speed up postoperative recovery.

As mentioned, however, surgery should be proposed in those patients in whom conservative treatments have failed or there is a significant reduction in quality of life.

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Source

Brugnoni