Spinal conditions, back pain and the evaluation of true or perceived spinal deformity are the most common reasons for parents seeking help at paediatric orthopaedic clinics.
The most common spine deformities are scoliosis (‘curved’ spine), and kyphosis (‘hunch-back’).
Scoliosis, or a side-to-side curvature of the spine, can affect children and adolescents of all ages. The most common type of scoliosis has a genetic predisposition and tends to aff ect thin females who are approaching or undergoing their pubertal growth spurt. The exact cause of this type of scoliosis – adolescent idiopathicscoliosis - has yet to be established and continues to be researched worldwide.
Less commonly, scoliosis can also be associated with conditions like Cerebral Palsy, Spina Bifida, Duchenne Muscular Dystrophy and Spinal Muscular Atrophy. It can also be associated with certain clinical syndromes such as Marfan Syndrome and Ehlers-Danlos Syndrome. When one or more vertebrae in the spinal column are imperfectly formed, the resultant scoliosis is termed ‘congenital scoliosis’.
Evaluation of a child or teen with scoliosis involves a full clinical examination with particular emphasis on examination of the spine. X-rays of the spine allow the severity of the scoliosis to be measuredin degrees; serial x-rays allow any progression to be detected. The pubertal growth spurt is the ‘dangerperiod’ during which a child’s scoliosis may progress significantly.
The goal of treating scoliosis is to prevent its progression. Very mild curvatures require observation only. Children with more severe scoliosis and who have signifi cant growth remaining may require the use of a back brace or orthosis. In some cases surgery may be necessary to arrest its progression.
At KK Women’s and Children’s Hospital (KKH), scoliosis surgery is performed by a team comprising of paediatricorthopaedic and spine surgeons supported by full-time paediatric anaesthetists and nurses. Spinal cord monitoring is carried out during the scoliosis surgery to prevent any potential nerve and spinal cord injury.
Kyphosis, or hunch-back, is another cause of great concern among parents.
In the majority of cases, this is the result of poor posture. Less commonly, a condition known as Scheuermann’sdisease can occur in adolescence causing a ‘roundback’ which can sometimes be quite severe and may require bracing or surgery. Kyphosis can also be associated with severe scoliosis causing kyphoscoliosis. Other causes such as tuberculosis of the spine are very rare these days.
As a rule, children should not get back pain. Therefore, back pain that is persistent or severe in children always warrants a thorough evaluation and work-up.
The majority of children and adolescents who experience back pain have acute back strain. This is usually the result of unaccustomed exercise or excessive exercise but may sometimes be due to an injury or poor posture. Back strain often improves after a few days or weeks following a period of rest. Occasionally, anti-inflammatory medication and a short course of physiotherapy may be helpful. High energy injuries can result in fractures of one or more vertebrae, but fortunately, this is uncommon. Children may also be born with a small defect in the spine called spondylolysis. This may occasionally cause back pain especially if it leads to spondylolisthesis when one of the vertebrae slips forwards on the one below. When back pain in children and adolescents is persistent or associated with fever, lower limb and/or bowel and bladder symptoms, further evaluation is indicated. Back pain that interferes with sleep or that requires pain killers is significant and warrants evaluation. In some cases an infection or a tumour may be causing the pain. The team of paediatric orthopaedic surgeons at KKH has a wealth of experience in evaluating children with back pain. Any persistent back pain in children should be seen by a doctor for evaluation and treatment.
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