bent and twisted

Bent and twisted
Your Health
DR GITA MATHAI




The hunchback of Notre Dame (Quasimodo), immortalised by the novelist Victor Hugo, was so deformed that he never ventured out of the cathedral. He suffered from scoliosis, a condition where his spine was bent “idiopathically” (for no known reason). He was not alone. The condition affects 2-3 per cent of the population. Some illustrious people who have not been spared by scoliosis are Hrithik Roshan, the Malayalam movie star Mohanlal and Eleanor Roosevelt. More girls than boys suffer from it. It is distributed across society, with both the rich and the poor being afflicted. The difference is that the rich can afford treatment while the poor cannot.

Normally, spines are elongated, elegant and mildly S-shaped, rather like a swan’s neck. In people with scoliosis it forms a “C” or an exaggerated “S”. Man stands upright defying gravity. Once the basic support system of the spine is bent, the person faces various problems. The appearance becomes grotesque. Other physical and neurologic problems may also arise.

The deviation in the spine may be so mild that it may remain undetected unless specifically searched for. The mother may merely feel that the child’s spine is not straight because of bad posture. Constant nagging, with the refrain “sit up, stand straight, don’t slouch” may begin. Others may blame scoliosis on food faddism, bad diet, over exertion, or carrying heavy back packs to school. Attempted correction of these variables produces no improvement. Parents don’t regard it as a disease process as the child usually does not have any associated symptoms like fever or pain.

In less than 0.1 per cent of people, scoliosis may actually have a cause. It may appear after an accident. It may also be associated with fever and eventually diagnosed as an infection of the bones of the vertebral column. It may be part of a generalised musculo-skeletal disease, in which case bones, joints and muscles other than those of the spine may be affected.

There is a genetic predisposition to scoliosis and several members of a family may be inexplicably affected over generations. These people do not suffer from any disease which could be responsible for this bent spine. It is idiopathic.

Scoliosis can be present from birth. More often it appears in childhood or adolescence as a painless rib “hump” or a prominent shoulder blade visible under a T-shirt. The uneven appearance may deter the person from wearing tight fitting clothes. The muscles on one side of the spine may develop abnormally. This may result in the shoulder and hip being at different levels on the two sides. The gait then becomes lurching.

In girls, scoliosis may cause one breast to appear unaccountably larger and more prominent than the other. Worried and puzzled parents doctor shop as they search for an answer and a cure.

Mild scoliosis may be detected only if the person is asked to lean forwards. Scoliosis is considered mild when the angle measured by the orthopaedic surgeon is less than 10 degrees. Eighty per cent of the cases in India fall in this category. These people have no symptoms and can lead a normal active life. In some, however, the curvature progresses and the angle gradually increases to 45 degrees or more. Symptoms usually begin to appear at this time. Pressure may be exerted on the contents of the chest. The heart and lungs may get displaced, leading to cardiac problems and breathing difficulties. Teenage girls with asymptomatic but visible scoliosis are distressed by their body image. They may withdraw from contact with peers and become depressed and isolated. In some people, like Quasimodo, the hump is so large that the person appears misshapen and grotesque.

There are several scientifically proven treatment options for scoliosis. Mild cases can be watched. Severe cases need braces, followed by surgery. Bracing techniques have improved greatly. Earlier braces were made of steel. Now they are made of lightweight synthetic materials. Modern braces are of the underarm type, which can be worn under the clothing. This means that the braces are comfortable and well tolerated, increasing compliance. In 75 per cent of the cases progression of the deformity can be prevented.

After the bony growth ceases, corrective surgery can halt the progressive deformity and produce a normal looking spine.

Unfortunately, in India, children with idiopathic scoliosis are not offered corrective therapy. Parents are fearful and reluctant. Naturopathy, massages, ayurveda, stretching, biofeedback, electrical stimulation and bizarre exercises are tried one after another. These have no proven benefit, and some are positively harmful. Poorly performed physical therapy, stretching machines and hot massages used intermittently can even cause neurological damage.

Scoliosis is correctable and treatable. Ignorance and financial constraints prevent many of our young people from accessing corrective braces and surgery. Eventually, like Quasimodo, they have to hide forever from society.


Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in