Adolescent scoliosis and its psychosocial impact

Scoliosis is a medical condition of the spine which causes it to develop a sideways curvature. When viewed from the back, the spine of an affected individual would resemble a “C” or “S”, as opposed to the normal straight structure. Scoliosis afflicting patients between 10 to 18 years is known as adolescent scoliosis, a very common paediatric skeletal deformity. Very often, the specific cause of adolescent scoliosis is unknown and is therefore referred to as adolescent idiopathic scoliosis or AIS (“idiopathic” implies arising from an unknown cause).

While a small proportion of adolescent scoliosis can be attributed to congenital abnormalities (caused at birth), few scientific studies have uncovered possible genes that could be responsible for this spinal deformity. Scoliosis could also arise due to an underlying nerve or muscular disorder, causing the progressive curvature of the spine. However, idiopathic cases of adolescent scoliosis are the most commonly seen today.

Early detection of adolescent scoliosis is possible by carrying out a routine physical exam. Few symptoms include one shoulder appearing higher than the other, uneven hips and prominent shoulder blade or rib protrusion. A definite diagnosis is done by physical tests like forward bending tests and spinal X-rays taken from various angles and sides. The diagnosis of scoliosis is made if the spine curves more than 10? to the left or right.

Early stages of adolescent scoliosis can be treated by non-operative care or physical therapy. Using a back brace or cast which will prevent further curving is recommended for patients whose backbone is still growing. If the spinal curvature is more than 45?, surgical intervention is recommended.

Surgery is advised in cases where the curvature has not just a cosmetic impact, but also hampers functions like breathing and poses a danger to the heart and lungs. Minimally invasive correction, endoscopic thoracic release and spinal fusion with instrumentation are some of the surgical methods used. The outcome depends on the age of the patient and extent of curvature. The greater the curve, the higher the chance that it will get worse as the person’s bones mature.

Research has indicated that girls have a higher predisposition to adolescent scoliosis compared to boys, with six to eight out of ten cases being girls. According to a study published by the Scoliosis Spine Centre of the University of Minnesota, adolescent scoliosis can lead to low self-esteem and suicidal tendencies or health-compromising behavior. The majority of the patients in the study were females as it is more prevalent in girls during late adolescence. The extent of deformity progression has also been found to be higher in females. Restrictions on physical activities, sports and requiring assistance to carry out tasks could have a detrimental effect on the child’s psyche, causing them to be self-conscious. Spine specialists work closely with counselors to discuss treatment options with the child’s family and help the patient with adjustment issues during this time.

Unfortunately, a large number of adolescent scoliosis cases affecting girls in India remain undetected. Due to a lack of proper information and medical facilities, many girls and families from small towns neglect this condition. Compounded by archaic beliefs in witchcraft or black magic, medical treatment is not sought out early-on and often the affected girl and her family members are stigmatized by their community. This further leads to cases of the patient suffering from depression.

Therefore, it is extremely important to have more awareness about this condition that plagues adolescents to eradicate the stigma attached to it. It is equally important to have a good support system in place for girls to overcome the cosmetic, psychological and sociological implications of this deformity.

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