When 14-year-old Bengalurean student Mira (name changed to protect privacy) was brought in for a consultation with spinal surgeon Dr Sajan Hegde of Apollo Hospitals, Chennai, her parents were beset with anxiety. As Mira grew into adolescence, her parents noticed an alarming change in her posture. The young girl began to favour her left side, and her left shoulder began to dip consistently below the right.
What had first seemed a case of bad posture, was soon revealed to be Idiopathic Adolescent Scoliosis, a condition in which the spine grows abnormally bent, pushing the whole of a person’s upper body out of alignment. For Mira’s parents, anxious worries abounded: Were they too late in bringing her to the doctor? Could Mira’s spine be fixed? Could she ever lead a normal life?
When he met them, Dr Hegde offered strong reassurances. Thanks to significant advances in spinal surgery, he explained, Mira’s condition was easily rectifiable and she would go on to living a happy, fully functional life. And just a few short months later, his predictions bore fruit. Not only was Mira’s spine surgically straightened, but the surgery was successful enough to let Mira even dance the Bharatanatyam.
What is scoliosis
Scoliosis is a sideways curvature of the spine, where the vertebral column that should be straight begins to curve into a “C”, or in some cases, into an “S” shape. “When the spine bends, the shoulders go out of alignment. The chest gets deformed and starts to protrude asymmetrically. The whole trunk of the person shifts to one side or the other,” explains Dr Hegde.
Milder cases of scoliosis can be managed without medical treatment or with the use of externally worn braces. However, severe scoliosis requires surgical treatment and can be life threatening, as it leaves the heart and lungs compressed within the deformed rib cage, leading to respiratory and cardiac problems.
While scoliosis can be congenital (starting at birth), most instances occur when puberty begins. Estimates say that the condition affects 0.04% of the population in the country. One of the biggest challenges of the condition, says Dr Hegde, is that its causes are unknown. “As the terminology ‘idiopathic’ says, we don’t know what causes this condition. A lot of research is going on in this area, but we still haven’t been able to identify them.”
What is known, however, is that scoliosis affects young girls much more commonly than boys. What’s more, girls are also more likely than boys to develop more severe forms of scoliosis. “In our spinal unit, the ratio seems to 6:1—for every six girls that we treat, one boy comes in,” observes Dr Hegde.
The cost of fear and misinformation
One major hurdle for treating patients with scoliosis, says Dr Hegde, is the lack of awareness among people. This means that, most of the time, patients come to specialists when the condition has progressed much further than necessary, making the surgical intervention needed more complex. “Initially if a child moves or stands oddly, parents will tell them to correct their posture. But if the posture issue persists, it’s important to consult a specialist as soon as possible,” says the doctor.
Dr. Sajan Hegde, Chief Spine Surgeon, Apollo Hospitals.
Unfortunately, he adds, even at the stage where parents decide to seek help, they often do not approach the right expert. “Some parents may approach a general physician, or even go to people like yoga specialists who claim to do many things. So, a lot of time can be lost before people realise that they are at a dead end,” he says. Even with many orthopaedics, says Dr Hegde, there is a lack of comprehensive understanding of the condition and the inputs of a spinal specialist are needed.
Sometimes, such delays can be extremely costly. Dr Hegde recalls the heartbreaking case of the son of a government official from Uttar Pradesh, who was brought in for a consultation. “From examining him, I realised that his condition had started at age 3 or 4 years. There is a small group of deformities that we call malignant, which means that they develop rapidly and affect the lungs and the heart. He had brought his child at the stage where his heart and lungs were so weak that they could not take the stress of the surgery. So, we were lost there,” he says.
Major advances in spinal surgery
Often, such long delays in seeking treatment can also arise from a fear of spinal surgery, explains Dr Hegde. However, he points out, the technologies in treating spinal disorders have vastly improved in recent years. With scoliosis, technological advancements have allowed for corrective surgeries to be done in a way that patients recover complete functionality, he asserts.
“Traditionally, we use rods which are fixed on the back of the spine, using implants at strategic levels, which are fixed onto the spine, and correct the deformity and hold it. And fuse the spine so that the spine remains straight forever,” he explains. However, such fusion surgery leaves the patient with some reduced functionality as the spine is unable to move flexibly. This was done in Mira’s case too.
How Mira's spine was corrected with the latest surgery. Images - before (left) and after (right) the surgery.
However, the spinal unit at Apollo Hospitals now employs cutting-edge non-fusion scoliosis surgery, where the rigid rods have been replaced by braided cables made of polyethylene terephthalate. These cables provide the tension needed to help the spine grow straight, but still provide the flexibility to allow the full range of back movement. Another major advance is the use of robotic tools to more precisely place the implants that secure the PET cables to the spine. It is these cutting-edge techniques and tools that have allowed Mira to pursue the Bharatanatyam she’s passionate about, says Dr Hegde.
Getting full quality of life
Scoliosis should not become a sentence to a lifetime of impairment, observes Dr Sajan. At the medical end, treatments are constantly improving to make procedures safer and more effective. But there’s also a need for people to develop awareness, so that they approach specialists early enough to make the maximum impact. “If people receive the right medical advice at the right time, and the correct interventions are done when needed, children with scoliosis can have normal, fully functional adult lives,” he asserts.
This article has been produced by TNM Brand Studio in association with Apollo Hospitals and not by TNM Editorial.