- Children’s Orthopaedic & Spine Care Clinic
Please do not panic. The first step is to take an appointment. You must bring all medical records and imaging studies (X-rays, MRI etc) with you. Please write down a list of questions that you might want to ask. There is information on this page that might answer all your questions.
You/ your child will meet Dr Sarup and his team members in the Child Ortho Clinic in Gurgaon
Dr Sarup will carry out a detailed evaluation for you / your child.
The physical examination usually includes an assessment of the spine, trunk balance, cosmetic deformity, a neurological examination and a check for any other associated anomaly. Height and arm span measurements will be carried out at this visit, and growth charts will be made. A standing radiograph (x-ray) whole spine will be carried out. Clinical photographs will be taken for maintaining patient records.
A plan of treatment will be formulated at this point. Additional tests will be ordered as a part of a comprehensive assessment. An MRI whole spine, a blood test, ultrasound scan of the abdomen, and a cardiac ECHO are usually done.
All patient data will be filed securely. Any patient related information will be shared only after due consent from the patients or their carers.
While every effort is made to treat scoliosis non-surgically, the final plan of treatment depends on age of the patient, severity of the scoliosis, scoliosis type, and the physical condition of the patient.
At our clinic, the various non-operative treatment modalities for Scoliosis treatments are:
When the curve is small (10-15 degrees), only observation is needed. Most children fit into this category when they are detected early. We start the patient on specialized exercises. Close monitoring is carried out with x-rays at regular intervals till end of growth.
4-year-old child with mild scoliosis. This will need bracing and exercises.
Very young children may develop progressive curves. In these children, surgery is not an option. However, these young children with flexible scoliosis respond to cast applications. Casts provide an effective option for controlling and reducing the abnormal spinal curvature at this age. Contrary to common perception, children tolerate casts very well.
We offer this treatment between ages 1-4 years in a child who has a progressive scoliosis.
The cast application is carried out under General Anaesthesia. This casting system follows a special technique of Elongation De-Rotation and Flexion of the spine. The casts are repeated every 4 months. Many children respond very well to this technique with a measurable reduction of the scoliotic curve. This is followed up with bracing and exercises.
Cast treatment: Showing precasting curve D7 to L1 of 74 degrees. After the first cast, the curve reduced to 24 degrees. Serial casts are applied under anaesthesia to obtain correction.
Please see the cast precautions section in out parent / carer education section.
Bracing is suitable for mild- moderate curves in a growing child. Braces have to be worn for 22 hours every day. These are removed for exercises and for bathing. Braces are usually continued till the end of growth. The aim is to restrict the spinal curve to less than 30 degrees thereby avoiding surgery. The braces do not cure scoliosis, but prevent the curve from progressing.
21 August 30 Degree Curve L1 to L5
In Brace August 2021 Curve Reduced to 19 Degree
February 2022 - Huge Improvement in The Curve. It is now 17 Degree even Without Brace and the child looks quite straight
At our centre, we advise a Boston brace or a Cheneau-Gensingen type of brace. The brace is individualized to each child. We partner with College Park Healthcare, a highly experienced orthotic service providers for scoliosis and other spinal deformities.
At our clinic, we offer therapy based on Schroth physical therapy method. This therapeutic system is highly effective in scoliosis in growing children. It also benefits adults with scoliosis.
The child is closely monitored for increase in height, curve flexibility, improvement with exercises and bracing. Radiographs are ordered every 4-6 months to monitor curve progress. Non-surgical treatment needs a lot of cooperation from the child. The effectiveness of bracing is directly proportional to the hours a brace is worn each day. Due to our extremely hot weather 9 months in a year, it is difficult for children to carry out bracing for long hours.
However, successful conservative treatment means that surgery can be avoided totally, or the amount of surgery is vastly reduced compared to no treatment.
While most children are treated by non-operative methods with follow up maintained till the end of growth, there are situations when surgery is required:
Sometimes scoliosis presents early in life, and does not respond to conservative methods like casting, brace application. These children develop severe large curves which need surgical interventions. However, these children are very young with a lot of spinal growth still to happen. The following surgeries are offered at our clinic for these patients;
Growing rod surgery
This is a fusionless method of correcting the spinal curve and allowing growth of the spine. The rods are fixed to the bent spine surgically. The rod placement allows substantial correction. Subsequently, every 6 months, a small operation is carried out to lengthen the rods and allow growth of the spinal column. This process is carried on till age 10-12 years. A final fusion with screws and rods is carried out at that stage.
Magnetic Growing rod surgery
Magnetic growth rods are the latest innovation in scoliosis surgery. Here, the process is similar to growth rod surgery for the first operation. These adjustable growing rods are inserted similarly and allow for correction of the curve. Subsequently, the magnetic rods are elongated without surgery by placing an external remote controller device on top of the skin and keying in a correction length. The corrective elongation of the rods happens automatically inside the body. This avoids the need for repetitive surgery and problems associated with multiple operations.
Early onset scoliosis at 1 year, treated by casts and then brace
He progressed to a 70-degree curve by age 4 years at which point growth rods were applied
Age 9 years 7 months. Growth rods have been expanded several times. Now has excellent correction. Curve 18 degrees
Curves over 50 degrees often need surgery. Usually, surgery is recommended towards the end of spinal growth. The decision to operate and the timing of it is unique to every case. The goals of surgery are to prevent further progression of the curve, and achieve a degree of curve correction. Screws are placed in individual vertebrae and connected with rods. The corrected spinal curve has bone material added to it so that the vertebrae can fuse with each other. The magnitude of surgery depends upon the severity of the spinal curve. For very severe curves, 2 stage surgery is required.
13-Year-old with a 50-degree D7 to L1 Curve. The child has developed smaller upper dorsal D3 to D6 27-degree curve and a lower L2 to L4 21-degree curve.
A patient usually spends 5 to 10 days after surgery in the hospital. Subsequently, we encourage physiotherapy and the use of a brace for 3 months. The brace is worn during out of bed activity. Patients return to normal activities after 3 months of surgery.
Scoliosis surgery is a major operation. It has risks of neurological damage. This risk is approximately 1% in idiopathic scoliosis. We minimize this risk by offering neuromonitoring during surgery. By neuromonitoring, we are able to prevent neurological injury in most patients.
Infection is the other major risk. The incidence in our centre is 1%. To minimize this problem, we conduct our surgery in laminar air flow Operating theatres, use standard Antibiotic prophylaxis and carefully perform the surgery by modern aseptic methods. The patients are carefully monitored in the post-operative period.
We like to optimize patient care and prepare the patient for surgery. The steps we take include prescribing an aerobic exercise schedule, high protein intake and supplements.
We encourage autologous blood transfusion wherever possible. In this system, an adolescent donates his or her own blood once a week till 3-4 units of blood are reserved. These are then used during surgery. This type of blood replacement is advantageous in many ways, since there are no minor transfusion reactions, and the blood demand of a patient is drastically reduced.
Fig. 11 year old with D3 to D10 117 degree curve, and a lesser curve D11 to L3 of 84 degrees. Since the Curves are severe, surgery was done earlier.
Fig. Xray 2 weeks after surgery. Excellent correction with surgery sparing lower mobile lumbar vertebrae. The balance improves over time and restricting the instrumented levels results in a near normal long-term outlook.
Here is one more example of our patients who underwent Surgical correction of severe curves
Fig. 14 year old female with severe scoliosis on xrays and spine deformity.
Post-operative xray and an excellent correction
The spine is made up of small blocks of bone stacked up on each other. These are called vertebrae. When we look at spine from the front, it has a straight shape. A diagnosis of scoliosis is made when there is a sideways bend in the spine. The side bending should be more than 10 degrees in order to be called scoliosis. Minor curvatures less than 10 degrees are quite common but are not called scoliosis.
Xrays of 13 year old female with 8 degree curve on AP film.
The child is 13 years and towards end of growth. This much curvature is normal.
Small curves in the spine are hardly visible.
Larger curves are quite visible from the back especially when the patient bends forward.
Congenital scoliosis:
Scoliosis is caused by abnormal shape of the vertebrae or defects in the spine which are present at birth. This type of scoliosis is visible and detectable early in life. It tends to get very severe with growth.
Neuromuscular Scoliosis:
This is caused by disorder of the nervous system – such as Meningo-Myelocoele and Cerebral Palsy. It can also result from muscle abnormality like Muscular Dystrophy. There are many other causes of neuromuscular scoliosis.
Idiopathic Scoliosis:
This is by far the most common type. In this type, there is no clearly detectable cause. Genetic factors are often at play in this group of patients. This is most commonly detected after age 9 years.
Scoliosis is quite common! It affects 1-4 % of the population. Most people have small curve that do not require treatment. 1 in 10 cases develop a spinal curve that needs treatment.
The clinical examination and a confirmatory radiograph ( X-ray) will clinch the diagnosis.
The easiest test to screen for scoliosis is called the Adam’s forward bending test.
The steps to carry out this test are:
This test can be easily carried out at home, classroom or the clinic.
There are other features in scoliosis which may be noticed such as;
Very often, parents fail to notice anything abnormal.
Any abnormality will need a further check by a paediatric orthopaedic surgeon.
Scoliosis increases rapidly in severity during growth period of a child, which lasts up till age 17 years. So growing makes scoliosis worse. This is not always true but happens in most cases.
Fig. Here is an example of scoliosis getting worse with rapid growth. This child was seen 11 years of age with a 27 degree D6 to D12 curve. The child did not follow up and was seen again 13 months later without any treatment. The curve had rapidly increased to 44 degrees. Once growth is complete, the curvatures do not increase if the curve measures 30 degrees or less. For curves over 50 degrees, progression does happen even after growth is complete. Usually, the increase is 1 degree per year. This is not much, but if a curve is 70 degrees at 17 years of age, it has a potential to increase by another 50 degrees by the time the patient is 67 years of age.
Some scoliotic curves that are present in infancy can resolve on their own.
Then occasionally, a spinal curve may be seen but this may not be a true scoliosis. It may be secondary to other pathologies, such as a spinal tumour, a syrinx, a vertebral infection, or even a disc prolapse. In these cases, correcting the underlying pathology corrects the scoliosis.
Scoliosis is more common in females. The incidence of larger curves is higher in females. Scoliotic curves in females are eight times more likely to progress sufficiently such as to require treatment. However, the results of brace treatment in females of growing age are better than in males.
The treatment depends on the severity of the curve and age of the patient.
An adolescent who has reached the end of growth with a small spinal curve and a balanced posture does not need any treatment.
A growing child who has a diagnosis of idiopathic scoliosis with a small curve not sufficient to necessitate treatment is kept on observation in our clinic till completion of growth.
A curve of 15 degrees in a child with significant growth remaining will need to be braced. We will also recommend scoliosis specific physiotherapy in our clinic.
A very young child with a rapidly progressive scoliosis will need cast treatment followed by bracing. Many such children need growing rods surgery if casting and bracing do not work. This is fusionless surgery and allows the spine to grow as the child grows while maintain correction.
Patients with large scoliotic curves are initially treated by bracing, scoliosis specific exercises and observation. Many of these patients undergo surgery towards end of growth to balance the trunk and correct the scoliotic deformity.
Most scoliotic curves are minor and may not progress to treatment. However, observation is essential and once the curve increases, measures like brace treatment and exercises are started.
The most effective treatment depends on the type of the curve and its magnitude and progress. Non-operative and preventive treatment following early detection is the best treatment. All efforts must be made to pick up scoliosis when the curve is small, and then treat it by bracing and exercises to keep the scoliosis to under 30 degrees. Early diagnosis by an alert clinician, early treatment with brace application and exercise program is important. There is good medical evidence for these methods. A child will lead a normal life if the scoliotic deformity remains less than 30 degrees.
The scoliosis can be greatly improved by an effective exercise regime which is available through our clinic.
The overall spinal balance and strength of the trunk can be improved with our exercise regime. This is possible even in older adults with high grade scoliosis.
No – there is no medical evidence that Ayurveda can cure scoliosis.
The life expectancy of mild to moderate idiopathic scoliosis patient is normal. Children with early onset scoliosis are at risk of developing compromised lung function and later cardiac problems.
Severe scoliosis will result in cardiac and pulmonary problems in the long term.
Many children with congenital scoliosis may have abnormality of the spinal cord, kidneys and the heart.
Please see ‘Scoliosis treatment’ as above.