Spine curvature disorders and spina bifida

Spine curvature disorders – Lordosis, Kyphosis, Scoliosis – are abnormal curvatures or misalignments of the vertebrae and discs of the spine.

 

Lordosis (swayback) the spine is excessively curved inward at the lower back

Kyphosis implies an abnormally rounded upper back (more than 50 degrees of curvature)

Scoliosis – the spine curves sideways in an S or C shape

 

Spina bifida (split spine) is a permanently disabling birth defect, part of a group of birth defects called neural tube (embryonic structure that develops in the baby’s brain and spine) defects. It appears when the neural tube does not develop or close properly.

Causes

Lordosis:

Achondroplasia – disorder in which the bones don’t have a normal growth rhythm (results in short stature in dwarfism)

Spondylolisthesis – abnormal forward position of a vertebrae in the lower back

Osteoporosis – vertebrae become fragile and easily breakable resulting in compression fractures

Kyphosis – abnormally rounded back

Discitis – inflammation of the discs caused by infections

Benign juvenile lordosis

Obesity

 

Kyphosis:

Congenital kyphosis – abnormal development of the vertebrae in the uterus

Improper postures (leading to postural kyphosis)

Spine tumors

Spine infections

Scheuermann’s disease (condition that causes misshaped vertebrae)

Osteoporosis

Arthritis

Spina bifida – birth defect, the spine does not completely develop in the uterus

 

Scoliosis:

In common types of scoliosis and adolescence-related scoliosis, causes are not known

Possible genetic factors (family medical history predisposition)

Infections

Birth defect

Injuries

Muscular dystrophy

Cerebral palsy

 

Spina bifida:

Exact cause is unknown

Genetic aspects, family history

Environmental factors

Possible folic acid deficiency

Symptoms and signs

Spine curvature disorders:

Lordosis:

Swayback appearance

In a lying position there is a big gap between the lower back and the surface

Back pain

Discomfort

Difficulty in movement

 

Kyphosis:

Abnormal head position (bent forward)

Hump or exaggerated curvature of the upper back

Fatigue in legs and back

 

Scoliosis:

Uneven shoulders – one is higher than the other

Uneven waist or hips

Leaning to one side

 

Spina bifida:

Three forms of different severity: spina bifida occulta, meningocele, myelomeningocele (“open spina bifida”)

 

Spina bifida occulta:

Mildest form of spina bifida

Small separation/gap in one or more vertebrae

Spinal nerves are usually not involved, resulting in no symptoms or neurological problems

Visible signs on the skin above the defect: abnormal patch of hair, fat “deposit”, small dimple, birthmark

 

Meningocele:

Rare form of spina bifida

The meninges (membranes that protect the spinal cord) come out through the spine openings

 

Myelomeningocele (“open spina bifida”)

Most severe form

Spinal nerves and membranes protrude through an opening in the spinal canal forming a sack on the baby’s back

Life-threatening infections due to tissue and nerve exposure

Leg muscle weakness

Paralysis (in some cases)

Bowel and bladder problems

Orthopedic problems – deformed feet, scoliosis, uneven hips

Seizures

Possible learning problems

Emotional and social problems

Advice

Spine curvature disorders:

 

The doctor reviews personal and family medical history and does a physical examination

 

Spine curvature disorders are usually visible but imaging tests (such as X-rays) will give a more precise overview of the problem

 

Regular exercise and normal posture are key in preventing some of the types of curvature disorders (such as postural kyphosis)

 

Surgical procedures for spine curvature disorders: spine instrumentation (hooks, wires are used to realign spine components and keep them in a normal position), artificial disc replacement, kyphoplasty (a balloon-like device is inserted into the spine in order to straighten and stabilize affected areas)

 

Lordosis:

 

Exercise and physical theraphy for muscle strength and improved flexibility and posture

 

Medication for pain and swelling

 

Back braces to correct position

 

Weight loss

 

Surgery

 

 

Kyphosis:

 

Exercise and physical therapy

 

Medication: anti-inflammatory drugs

 

Back braces

 

Surgery (for severe curvatures and congenital kyphosis)

 

 

Scoliosis:

 

Back braces – to prevent the curvature from getting worse

 

Surgery – for severe cases that continue to worsen

 

Chiropractic treatments

 

 

Spina bifida:

 

Prenatal screening tests are recommended to foresee possible problems in the baby’s development

 

Blood tests for spina bifida: maternal serum alpha-fetoprotein (MSAFP) test – to check for a protein that is produced by the baby’s body and at high levels can indicate a neural tube defect, triple screen or quadruple screen tests – along with MSAFP other hormone levels are observed: HCG (human chorionic gonadotropin), inhibin A and estriol (these tests are used in screening for Down syndrome)

 

Ultrasound screening – to detect signs of spina bifida

 

Amniocentesis – a sample of amniotic fluid is collected through a needle in order to check for elevated levels of AFP (alpha-fetoprotein)

 

Spina bifida occulta usually does not require any kind of treatment

 

In meningocele, the meninges (membranes) can be surgically put back into place and the vertebrae openings closed

 

Myelomeningocele requires surgery in the first 24-48 hours after birth to help minimize infection risks and further trauma; exposed tissue is covered with  muscle and skin

 

Prenatal surgery: the spinal repair is performed in utero before the 26th week of pregnancy

 

In the case of myelomeningocele, further operations are required for various complications because irreparable nerve damage is already present

 

Paralysis, bladder and bowel control problems often persist afterwards regardless of the interventions

 

Cesarean birth is recommended as in many cases with myelomeningocele the baby is in a breech position (feet-first position)

 

In most cases, the child will need to learn to use assisting devices such as crutches, braces and wheelchairs

MISCONCEPTIONS
  • Surgery is inevitable in scoliosis so anything a person does up until that point is useless

     

    Scoliosis only develops in a child’s growth stage so, post-growth stage scoliosis stops progressing

     

    Scoliosis is preventable

     

    Bed rest and inactivity are best for managing symptoms in spine curvature disorders

     

    All infants born with spina bifida do not live long or are stillborn

     

    Children with spina bifida have very low IQ scores

     

    Taking the right amount of folic acid while pregnant guarantees that the baby will not develop spina bifida

Statistics

 

Scoliosis prevalence in adults over 60 years old: 68%

 

Minimum estimation for adult scoliosis in the US: 5.88 million people

 

Adolescent idiopathic scoliosis prevalence: 0.47-5.2 %

 

Spina bifida is more common among whites and Hispanics

 

In the US, around 1,500 babies are born each year with spina bifida

Did you know?

Prolonged bed rest leads to muscle atrophy and overall deconditioning (the body adapts to a less demanding environment). So in means of recovery or prevention, it is best to have an active life style.

 

Scoliosis in adults can progress 1-3 degrees every year depending on age and life style.

 

People with spina bifida occulta often find out about their condition by accident when getting checked up for other affections.

 

Taking folic acid reduces the risk of having a baby with spina bifida.

 

Actor Rene Kirby, Bruce Payne, Mexican artist Frida Kahlo are only some of the examples of fruitful living with spina bifida.

 

Spina Bifida Awareness Month: October