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Adult & Pediatric - Orthopaedic Specialists Adult & Pediatric - Orthopaedic Specialists
 

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Spine

Neck :: Scoliosis

Neck

The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and also less protected than other parts of spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumours or congenital abnormalities of the vertebrae. Common conditions producing neck pain include:

  • Rheumatoid arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues, and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.
  • Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. As a result of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal aging or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.
  • Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
  • Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.
  • Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to aging. As people age intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics resulting in neck pain.

Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatment options include rest, ice application, elevation of the injured area, use a soft neck collar and neck immobilization using a splint, cast, or sling. Medications such as anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles.

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine.

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercise to prevent undesirable stress and tension to the neck muscles
  • Perform stretching exercises for your neck before and after exercise
  • Keep good posture if you work at a computer and adjust the monitor at your eye level. Stretch your neck frequently
  • If you use the telephone a lot, use a headset
  • Use a pillow that keeps your neck straight
  • Wear seat belts and use bike helmets to reduce injuries

 

Scoliosis

Scoliosis is a condition where there is abnormal lateral curvature of the spine that makes the spine appear as “S” or “C” curve. It can occur at any age and is seen more frequently in girls than boys. The exact cause of idiopathic scoliosis is unknown in most of the cases.

Types

There are three types of idiopathic scoliosis based on the age of occurrence.

  • Adolescent idiopathic scoliosis: It is the most common type and occurs after the age of 10 years.
  • Infantile idiopathic scoliosis: It occurs in children below 3 years and may be present at birth (congenital) or associated with various syndromes or neurologic disorders.
  • Juvenile idiopathic scoliosis: It is quite uncommon and occurs in children between the ages of 3 and 10 years.

Idiopathic scoliosis does not cause any pain, nerve dysfunction, or breathing problems. Child’s overall appearance will be the main concern in parents.

Diagnosis

Your doctor will perform Adam’s forward bend test to check if any deformity is present. During this test your child is requested to bend forward. The diagnosis can then be confirmed by measuring the curve with the help of an X-ray of the spine.

Treatment

The treatment of scoliosis is important because if left untreated, the curves measuring more than 50° may cause long term problems such as decrease in lung capacity leading to restrictive lung disease. The kind of treatment needed depends on the degree of the scoliotic curve, the child’s age, and the time period remaining for the child to reach skeletal maturity.

  • Nonsurgical treatment
    • Observation: If there is only a mild curve (less than 20°) or if the child is nearing skeletal maturity, regular check-up for every 3-6 months will be sufficient.
    • Bracing: Bracing is done to prevent the progression of scoliotic curves. It is effective in growing children with a spinal curvature between 25° and 45°.
  • Surgical Treatment

    Surgical treatment is recommended in cases where the curve is greater than 45° and who have reached skeletal maturity having scoliotic curves that exceed 50° to 55°.

Procedure

During the surgery, an implant made up of rods, hooks, screws or wires are used to straighten the spine. Bone grafting may also be done to the operated portion of the spine, to promote healing. Bone grafts can be obtained either from the bone bank or from the patient’s own hip region.

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