New Delhi, March 2022: 13-year-old Alka (name changed) wasn’t performing well in her studies due to the excruciating pain in her back. Her hunched back deformity has made her low in energy, self-confidence and self-esteem. When she visited the OPD of the Indian Spinal Injuries Centre (ISIC), New Delhi with her parents, she was diagnosed with Scheurmann kyphosis. It’s a condition in which a child develops rounded back deformity or kubadh in layman language, that needs immediate surgery.
Doctors say that in this deformity the vertebrae (the interlocking bones that form the spinal column) grow more posteriorly as compared to anteriorly. This leads to kyphotic or round back deformity affecting the upper back. In this patient, the cobb angle (a measurement of the degree of side-to-side spinal curvature) was 80 degrees (which normally is around 20 degrees) and was progressively increasing. Doctors decided to performed Smith-Petersen osteotomy, a technique in which the shape of the spine is changed so that she can look like a normal child of her age. The aim of the surgery was to decrease kyphosis by inserting modern spinal instruments like screws and rods, thereby making the spine supple.
The delicate surgery lasted for around 8 hours and was a success. The patient was walking normally without any support the next day after surgery.
“This condition is not very common in Indian children. It is more common in boys than girls. Scheurmann disease becomes more common during 10-15 years of age when a child starts to attain puberty. Not all Scheurmann kyphosis needs surgery. If deformity is mild to moderate it can be managed by braces and observation. Once cobb angle exceeds 75 degrees surgery is recommended because Hunched back or kyphotic deformity leads to back pain. Prominent deformity leads to low self confidence. These deformities increase over a period of time and can have negative impact on cardio respiratory status of the child as well, Our team performed Smith Peterson osteotomies, a kind of surgery in which spine joints (facets) are removed from the back to make the spine more supple which helps in deformity correction,” says Dr Rajat Mahajan, Spinesurgeon, Indian Spinal Injuries Centre (ISIC), New Delhi.
The complete procedure is safe and performed through neuromonitoring, in which the surgeon keeps close monitoring on the motor-power of the legs. That’s why there is no risk with this surgery as the chances of having paralysis post-surgery are almost nil.
It’s still unknown why some kids get it, but Scheuermann’s kyphosis runs in families. When a child has Scheuermann’s, the front edge of some of the vertebrae in the upper back grows slower than the back edge. These vertebrae become wedge-shaped, so when the vertebrae stack up, the spine curves, making the background out.
“It is a rounded back deformity. If you ask a child to touch toes with knees straight this deformity will become more apparent. Some amount of kyphosis is normal in every child ( up to 45 degrees). In Scheurmann kyphosis it is more than normal. Many of these patients also do not require surgery. Normal kyphosis is up to 45 degrees. In Scheurmann it can increase up to 100 degrees also. Once kyphosis exceeds 75 degrees surgery is recommended. It’s important to recognise this condition. Braces can help in children where kyphosis is less than 75 degrees. Most kids, if followed, can avoid surgery. Surgery is recommended once it crosses 75 degrees. During surgery also, it is recommended to not over correct the deformity,” says Dr. Mahajan.
“We are proud to give the girl a new lease of life. ISIC is the most advanced spine, orthopaedic and neuromuscular surgical centre in India. Our goal is to reach the lives of thousands of newly spinal injured every year by providing medical excellence through scientific expertise and to optimize self-sufficiency and independence for the rehabilitation patient,” said Sugandh Ahluwalia, Chief of Strategy, Indian Spinal Injuries Centre, New Delhi.
