Spinal deformity: Monitoring and correction

Monitoring of spinal deformity:

The various points which need to be kept in mind are as follows:

  1. These children need continuous monitoring of spinal deformity and it is well known that there is around 80% chance of development of scoliosis in SMA requiring surgery.
  2. X rays taken at regular interval is the standard of care, which is universally accepted.
  3. However, in this current situation of Covid 19 pandemic, these children should be monitored for clinical progression of spinal deformity. This can be best assessed by the ability of the non-walkers (wheelchair bound) to sit comfortably and maintaining an erect posture.
  4. If deterioration of the sitting balance occurs or the child becomes uncomfortable on prolonged sitting, suspect a progression of spinal deformity.
  5. Worsening of sitting comfort and tolerance should be taken up as a sign of progression of scoliosis or kyphosis, until and unless proved otherwise.
  6. The parents should also be on the lookout for increasing hump on the back. This can easily be picked up if the sitting child is viewed from the top, over his or her head -the prominence of the back, usually on one side is an important tip to assess the amount of spinal deformity.

Bracing

1.  Bracing is commonly done for scoliosis in SMA kids. Obviously during the growing period of the child, they frequently outgrow their brace and hence this needs continuous adjustment.

 

2.  Failure of such continuous adjustment leads to ill-fitting brace which might lead to pressure sores over the bony prominences.

 

3.  Regular opinion from orthotist, preferably through sharing of pictures online should be done by the parents and care givers so that necessary brace adjustments could be achieved.

Surgery

Routine surgeries need to postponed during this period of pandemic. However, a condition requiring an urgent surgery, need to discussed with a spine surgeon as per need.
Last, but not the least, it should be borne in mind that Covid 19 is unlikely to wean out into the oblivion in the recent future. Hence all measures of reassurance should be given to parents and care givers with the understanding that social distancing and lifestyle modifications, which are suggested by published guidelines, from time to time, should be translated into practice. This will ensure the huge societal need to overcome this pandemic in the true sense of the term.

Resources:

  1. Chhabra, H.S., et al., COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons. Indian Journal of Orthopaedics, 2020.
  2. Wijngaarde, C.A., et al., Natural course of scoliosis and lifetime risk of scoliosis surgery in spinal muscular atrophy. Neurology, 2019.
    93(2): p. e149-e158.
  3. Basu, S., Impact of COVID-19 on spine surgery: How can we work towards evolving best practices.Indian Spine Journal, 2020.
    3(2): p. 129-130.