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SPINAL DEFORMITY

Deformity

Spinal deformity can happen at a very young age or in an elderly. We have the expertise to treat congenital scoliosis in children as young as 1-2 years to adolescent.

Dr Balamurali, leading spine surgeon in Chennai gives particular emphasis on restoration of normal global and regional spinal balance. State-of-the art spinal cord monitoring techniques are employed by neurophysiologists in the operating rooms to provide the highest levels of patient safety. Navigation is used in complex deformities.

Conditions Treated Include

Adult degenerative scoliosis
Adult idiopathic scoliosis
Congenital deformities
Failed-back syndrome
Kyphotic deformity
High grade spondylolisthesis
Ankylosing spondylitis
Rheumatoid arthritis

We also have good experience in managing elderly patients who develop degenerative scoliosis as a result of age and osteoporosis.

Scoliosis

Scoliosis is abnormal sideward bending of the spine. There are various causes for scoliosis of which genetic cause is seen in almost 30 % of the patients. Contrary to the popular belief, abnormal loading like carrying heavy school bags or poor posture cannot cause scoliosis. Depending on the cause, scoliosis is classified into

Congenital scoliosis
Neuromuscular scoliosis
Syndromic scoliosis
Idiopathic scoliosis
Degenerative scoliosis
  • Congenital Scoliosis

    Present from the birth and is due to defective formation or development of the vertebral bone. This condition needs immediate detailed evaluation as it is usually associated with anomaly in spinal cord, brain and other organs including heart, kidney, gastro intestinal tract and other bones.

    Neuromuscular Scoliosis

    Scoliosis secondary to the abnormality in muscles and nerves like cerebral palsy, muscular dystrophy and spinal muscular atrophy. The weak nerves and muscles are not capable of supporting the spine leading to its curvature. X-ray of the spine shows a typical long ‘c’ shaped curve.

    Syndromic Scoliosis

    Associated with syndromes like connective tissue disorders and neurofibromatosis. The progression or worsening of scoliosis is rapid in this group of patient and so close monitoring and early intervention is necessary.

  • Idiopathic Scoliosis

    The exact cause of the scoliosis is not known and it is the most common type. Girl children are more affected than boys and is usually noticed after 10 years of age until they reach full growth limit (skeletal maturity)

    Degenerative Scoliosis

    Due to wear and tear of the disc and facet joint in spine and usually seen after 50 years of age. Unlike other types of scoliosis, degenerative one is associated with back pain and radiating pain in the legs.

Symptoms:

Tilted or uneven shoulders (one above the other)
Asymmetry of the rib cage
Uneven waist line and hip level
Hunched back and unequal limb size in severe cases
Pain is rare in scoliosis

What are the treatment options for scoliosis?

Observation with periodic evaluation 
Bracing
Physiotherapy
Surgical deformity correction

Treatment depends on the cause of scoliosis, age of the child/patient, severity of curve and associated anomalies.

When surgery is indicated?

If associated anomaly in brain or spine like cord tethering, diastomyelia or Arnold Chiari malformation is present, they should be treated first

Congenital scoliosis:

Usually bracing or body cast application is done up to 6 years of age and then assisted growth technique (growth rod application and serial distraction) is done up to the age of menarche. Around menarche when the growth spurt  happens, definitive surgery (deformity correction and fusion) is done.

Adolescent idiopathic scoliosis:

Need for surgery depends on
Age
Severity of curve
Skeletal maturity(determined with x-ray) (i.e growth remaining)

For curves up to 30° periodic follow up with x-rays has to be done. Curves with angle of 30° to 40° needs bracing and close monitoring. Curves more than 40-45° in children with growth potential should be corrected with surgery (posterior instrumented deformity correction and fusion).

What are the safety precautions taken during Scoliosis surgery?

Scoliosis surgery are very complex operations and must be performed only in centres that have adequate facilities and experiences surgeons. At Kauvery hospital we have both and we use several safety precautions to avoid any neurological deficit or complications.

Equipment used are:

Intergrated Neuro Spine Operations Theatre
Neuro Navigations (Robotic Guided) surgery
High speed drill and Ultrasonic Curator
Intergrated Neuro Spine Operations Theatre
Neuro Navigations (Robotic Guided) surgery
High speed drill and Ultrasonic Curator

What is Intra-operative monitoring ( IOM) ?

Intraoperative neurophysiological monitoring has been utilized to minimize neurological morbidity from surgery. The goal of is to identify changes in brain, spinal cord, and peripheral nerve function prior to irreversible damage. 

Detect neurological injury during  surgery on brain, spinal cord or nerves
Use of neurophysiological parameters for detecting changes which will alert if any surgically induced insults occur
To assess the function of spinal cord transmission function during an operation

Monitoring modalities?

Evoked Responses : Sensory pathways : Somatosensory evoked potentials (SSEPs)
Corticospinal tracts : Motor evoked potentials (MEPs)
Electromyography (EMG) : Free-run, Stimulated
“D waves” for spinal cord tumor surgery
Function mapping of cranial nerves especially facial nerve during nerve sheath
tumour surgeries
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Degenerative scoliosis Case Example:

67 years old female presented with the complaints of low back ache radiating to posterior aspect of thigh for past 1 year. History of urinary incontinence (+) for the past 6 months & symptoms worsened for the past 2 months. She had difficulty in sitting, standing and walking on her own, and was totally dependent on care giver. 

Diagnosis: Degenerative scoliosis

Treatment: D11 to L5 instrumented deformity correction, decompression and fusion.

Outcome:  Patient was started on osteoporosis medications and has significant relief from leg symptoms. She is now an independent woman taking care of her activities of daily living.

Case Example:

12 year old child with cosmetically and functionally disabling deformity in the back

Diagnosis: Congenital scoliosis with hemivertebra and unsegmented bar

Treatment: Deformity correction with vertebral column resection(VCR) and cage reconstruction

Outcome: child returned to normal life with good self-esteem

We are capable of correcting simple to complex curves through 360 degree fusion with maximum safety

In Association With

Spinal defects

  • Congenital Cervical Spine Anomaly
    Congenital spine deformity
    Scoliosis surgery
  • operative Neuromonitoring
Dr.G.Balamurali
Dr. G. Balamurali is one of the leading spine surgeons in Chennai. He is internationally trained in all niche aspects of Spine Surgery. He has over 24 years of surgical experience in this field.
Kauvery Hospital,
No.199 ,LUZ Church Road,
Mylapore,Chennai– 600004
Tamilnadu, India
Kauvery Hospital Front Area

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