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PART 1 WORKING WITH THE CHILD AND FAMILY: Information on different DisabilitiesB. Recognizing, Helping with, and Preventing Common Disabilities 161 CHAPTER 20Spinal Curve and Other Back Deformities The backbone, or 'spine', is a chain of bones called 'vertebrae' that connect the head to the hipbone. Separating each of the vertebrae is a small cushion called a 'disk'. The backbone holds the body and head upright. It also encloses, in its hollow center, the 'spinal cord' or trunk line of nerves connecting the brain to all parts of the body (see Page 35).
Of these different problems, scoliosis or a sideways curve is the most common serious problem. Often, however, rounded and/or swayback are seen together with scoliosis. NON-FIXED AND FIXED SPINAL CURVES With a non-fixed or 'functional' curve there is no deformity of the vertebrae. This usually happens when the body tries to stand straight even though the hips tilt or there is other unevenness not in the spine.    Fixed or 'structural' curves are deformities in the bones of the back themselves.
162 CAUSES OF SPINAL CURVE (SCOLIOSIS)Most scoliosis (about 80%) occurs in otherwise healthy children for no known reason. Sometimes it occurs in several members of the same family, so there may be a hereditary (familial) factor. Although about 1 of every 10 persons has some scoliosis (if looked for), only about 1 in 400 has enough of a curve to be a problem. Curves of unknown cause are often first seen-and progress quickly-in children from 10-16 years old, during the period of rapid growth. Known causes of fixed scoliosis range from infection to tumor to rare disease. When possible, consult a doctor with experience in these problems.   These problems can only be identified by X-rays.Some children are born with fixed scoliosis, or develop it in early childhood, because of defects in the spine itself. Non-fixed scoliosis always results secondary to other problems, such as uneven paralysis of the back muscles, or a hip tilt (often due to a shorter leg). Spinal curve often develops in children with polio, cerebral palsy, muscular dystrophy, spina bifida, spinal cord injury, arthritis, and dislocated hip. Be sure to examine all children with these disabilities for spinal curve. With time, non-fixed curves may gradually become fixed. Examining for spinal curveThis is discussed in the chapter on physical examination (Chapter 4).   
CHECK FOR:   When you examine for scoliosis, also check to see if the curve   163 What to doThis will depend on:
How severe the curve is and whether it is getting worse can be best measured by X-rays.  1 . For each curve, pick the 2 vertebrae that tilt most in relation to each other. 2. Draw lines level with the top of each vertebra.  3. Measure and record the angle of the spinal curve.  4. Regularly record the curve and notice any changes. Because X-rays are expensive and often hard to get, you can get some idea of whether the curve is getting worse by measuring the angle of the rib hump.  Be sure the top piece is completely level. You can use a carpenter's level or a homemade one (see box). Have the child stand or sit as straight as possible, while he bends forward.
If the rib hump angle stays about the same month after month, the curve is probably not getting worse. Keep checking it every few months. If the rib hump angle increases steadily, the curve is getting worse. X-rays should be taken and a decision made about what to do. Non-fixed curves that are not getting worse should usually be treated only by doing something about the underlying problem. For example, if the child's spinal curve is not fixed and comes from a hip tilt due to unequal leg length:
   164 Body jackets or bracing for a non-fixed curve usually do not help to correct the curve or even to prevent its getting worse. However, for a child with a curve so severe that it makes sitting or walking difficult, a body jacket or corset may help.
Spinal curves under 20° (fixed or non-fixed) usually need no special care - other than to be watched, and measured every few months to see if they are getting worse.  Some experts say that exercises to strengthen the back muscles, like this, help correct and slow down the curving of the spine. Other experts say it does no good. (We do not know.)  Spinal curves over 20°, if they are fixed and getting worse, may get worse less quickly with a brace.  A brace like this (the Milwaukee brace) is often used. It works because it is so uncomfortable that the child must stretch his body as straight as possible to reduce the discomfort.  A plastic 'Boston brace' like this is more comfortable, can be completely hidden under the clothes, and probably does as much good. SURGERY For spinal curves over 50° which are quickly getting worse, surgery may be needed. Surgery 'fuses' (joins together) the most affected vertebrae. Usually it only partly straightens the spine. Except for very severe curves, surgery should be avoided in children under 12 years old because the fused part of the spine will not grow any more. If the curve of the spine is less than 40° by the time the child stops growing, usually it will not progress further. If the curve is over 50°, it is likely to keep getting worse even after the child stops growing, and surgery is often recommended. However, 'spinal fusion' surgery is very costly and requires an orthopedic surgeon specially trained in this operation. It can also be very hard on the child and family. When surgery cannot be obtained, a body jacket or brace should perhaps be used to help slow down the curve's progress. When a curve becomes too severe, there is no longer enough room in the chest for the lungs and heart to work well, and the child may get pneumonia and die. EXERCISES FOR ROUNDED BACK AND SWAYBACK  Children with rounded back may benefit from exercises to help straighten it, like this.  These exercises are explained in the Exercise Sheet #5, Page 387. The child should also be encouraged to sit and stand as straight as possible, with the shoulders back.  Children with swayback may benefit from exercises to strengthen the stomach muscles, like this,  or by exercises to correct hip contractures (if the child has them). See Exercise Sheet #3, Page 385. Go back to the CONTENTS Disabled Village Children A guide for community health workers, rehabilitation workers, and families by David Werner Published by The Hesperian Foundation P.O. Box 11577 Berkeley, CA 94712-2577 Copyright © 1987 by the Hesperian Foundation 2nd edition, 5th printing February 1999 |
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