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Tuesday, Aug. 28, 2018

Childhood Scoliosis


Many options exist for treating curvature of the spine

No medical problem is insignificant to parents when it comes to their own child because we all want what is the best solution for him or her. Even a small cut on a finger sometimes can trigger fear among parents. So, it is only natural to fear the worst-case scenario when a parent hears, “Your child has scoliosis.”

Scoliosis is a condition describing an abnormal curvature of the spine, otherwise known as “S-curve.” The severity of curvature can be measured on X-ray studies using “Cobb angle” measurements. If the angle is greater than 10 degrees, a diagnosis of scoliosis is determined. Fortunately, scoliosis is a treatable problem, and not everyone requires surgery.

There are many causes of childhood scoliosis, which are classified as: idiopathic (does not know the cause), neuromuscular (cerebral palsy), syndrome related (genetic disorder) and congenital (malformed vertebrate). It can be diagnosed as early as within few weeks after birth (early onset), toddler (juvenile) and adolescent (pre-teen to teenage). The majority of cases can be treated conservatively with close observation on serial X-rays during growth years. Sometimes external orthotics using a back brace may potentially slow down or stop the progression of scoliosis.

When a Cobb angle becomes greater than 45-50 degrees, the parents will usually be counseled by a spine surgeon to consider a possible surgical correction of scoliosis. It is based on the high probability that the curvature is likely to progress at about 1 degree annually if left surgically untreated. Simple math will conclude that a child with severe scoliosis will suffer adverse effects to vital organ functions during his/her lifetime if the curve progresses at that rate. Unfortunately, there is not an alternative treatment option when scoliosis is at greater than 45-50 degrees; however, it is a decision the parents have a right to make for their child. Continued observation can be an option, but it is important for the parents to understand possible negative effects of severe scoliosis if the curve progresses.

Although there are many surgical options available, most cases will involve spinal fusion using metal screws and rods to realign the spine and stop the curve progression. It is usually done with a long midline incision in the middle of back. X-rays will be done to guide a surgeon to precisely and safely insert screws into the vertebrates. Some parts of the vertebrate will be removed to mobilize the spine to properly correct the scoliosis. Multimodality neurophysiological monitoring is conducted to assess motor and sensory functions in the operating room even though a patient is under general anesthetics. The overall complication rate is less than 5 percent, including any neurological problems after the surgery. The majority of children will be able to resume normal daily activities and participate in sports within six months after surgery.

Shriners Hospital for Children in Shreveport has been a regional referral center for childhood scoliosis for more than 50 years. Patients from Texas, Oklahoma, Arkansas, Mississippi, Alabama and Louisiana come to Shreveport to receive treatments for scoliosis. Approximately 100 cases of scoliosis are performed annually.

Dr. Anthony Sin joined the LSU Health Shreveport Department of Neurosurgery faculty in 2008 after completing his neurosurgery residency at LSU Health Shreveport and a spine fellowship at the University of Tennessee in Memphis. He has also completed a fellowship in neurotrauma at Mount Sinai School of Medicine, an internship in internal medicine at Emory University, and an additional internship in general surgery at the State University of New York in Stony Brook. Dr. Sin’s clinical interests include minimally invasive spinal instrumentations and complex spinal disorders, including deformity corrections and spinal tumors. He regularly performs surgeries and consults at Shriners Hospital for Children in Shreveport, Willis-Knighton North and the University Neurosurgery Clinic located in the Medical Arts Building of Willis-Knighton Pierremont.


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