Two new treatment methods here spell hope for children with severe spinal deformity. JOAN CHEW reports
The common refrain to a child to “sit up straight” would be painfully difficult for one group of children whose problems with their spines go all the way back to birth. Children with congenital scoliosis have a curvature of the spine that results when their spinal column develops abnormally in the womb. They also have abnormal bone segments of the spine, such as a missing vertebra or partial formation of a vertebra (hemivertebra), the lack of separation of the vertebrae, and a combination of such problems. The cause of these abnormalities is not known.
About a third to half of these children will have problems related to the heart, kidney or bladder as well, said Dr Kevin Lim, senior consultant at the department of orthopaedic surgery at KK Women’s and Children’s Hospital (KKH). As the spine, kidneys and heart develop from the same embryological tissue type, any abnormality may affect some or all of the tissue types, he explained.
Worldwide, about one in every 10,000 babies is born with congenital scoliosis. Dr Lim, who is also the deputy chairman of the division of surgery at KKH, estimates that Singapore has about 500 children with the problem. KKH picks up 10 to 15 cases every year, with some coming from overseas, he said. At the National University Hospital, there are at least 30 each year, said Associate Professor James Hui, who heads its division of paediatric orthopaedics.
Other types of scoliosis that hit children are idiopathic (without any known cause), or neuromuscular, which results from a disorder of the neurological system, such as cerebral palsy, spina bifida, muscular dystrophies and spinal cord injuries. Unlike congenital scoliosis, in which there are problems with both the shape of the spine and the vertebrae, idiopathic and neuromuscular scoliosis involve only a sideways curvature of the spine. They can occur at any age, up till adolescence.
Treatment for scoliosis depends on how curved the spine is as the child grows. Doctors will try to put off drastic treatments to correct the curvature until after puberty, as far as possible, when the spine has reached full growth. Mild cases, where the curvature is less than 20 degrees, are not treated but observed only. A brace worn like a vest around the body is used when the curvature reaches 35 degrees to prevent it from worsening. Spinal fusion surgery, in which doctors fix the spine in place with an implant made of rods, hooks and screws, is the last resort.
For adolescents, this is considered only when the curvature hits 45 degrees, said Dr Tan Chong Tien, an orthopaedic surgeon at Mount Elizabeth Medical Centre. In young children, doctors wait to see if the spinal curve is likely to progress beyond 45 degrees before putting the child through such an ordeal, so as not to limit the growth of the spine. Besides having to live with an unsightly curved spine, young patients may develop breathing difficulties from scoliosis if the spine is so twisted that the lungs are compressed in the rib cage.
About 10 years ago, nothing could be done to address this problem without resorting to spinal fusion which would retard a child’s growth. But in recent years, two hospitals here have introduced treatments that can mitigate this complication until the child is ready for surgery.
While no one has been known to have died from breathlessness arising from scoliosis, Dr Tan has seen a “very severe” case of juvenile idiopathic scoliosis, which made it necessary for the patient to be hooked up to an oxygen tank. For such patients, a brace could provide support to the spine, but it would do little to help in expanding the chest, he said. The new treatment methods can help improve the child’s breathing and quality of life, said Dr Lim.