Author:
Professor Dr. Syed Arif Kamal Next Article Printable Version PDF
Scoliosis,
lateral curvature of the spinal column, effects children in their growth
period. If recognized early the deformity may be treated by a combination of
exercises and braces. However, if it reaches advanced stage it may disfigure
the body, cosmetically, and may affect vital organs, like heart and lungs. At
this stage, the only recourse is major spinal surgery. Since spinal column is
the site of many nerves, which control our motor system, any damage to these
may cripple the patient. Professor Dr. H. Neugebauer of Orthopadisches
Krankenhaus Gersthof, Vienna, Austria, a well‑known Orthopedic Surgeon and host
of an Orthopedic Conference in 1988, mentioned that he operated on a girl for
scoliosis and she was paralyzed from the waist down. What can the parents do to
save their children from the pain and the suffering, which the above patient is
bearing?
The spinal column of girls is more flexible than that of
boys. The incidence of scoliosis is also in the ratio of 5 to 1 in girls as
compared to that in boys. Scoliosis has no symptoms and is
recognized, only, by the deformity it produces in the body.
During the
school‑going period make sure that the children do not carry unnecessary books
in their school bags. The school bags should not be carried on one side. They
should be worn properly on the back exerting load evenly on both sides. The
best way to avoid these complications and major surgery is to monitor young
children for the curvature of spinal column. The parents may help recognize
many cases early enough to avoid surgery by keeping a watchful eye on their
children between the ages of 5‑10 years.
The very
first clue of any back asymmetry shall come by observing the soles of a child's
shoes. If the soles are asymmetrically worn out there is a strong suspicion
that there is something wrong with the skeletal system. Another clue could be
the asymmetry of knee joints observed when the child is standing erect, facing
the examiner, feet together.
It is
recommended that the parents conduct the following checks every six months, and
a record maintained on the child's health book, especially if one of the parents or the siblings
(brothers/sisters) has a back problem. The
check would be noted as positive, if it indicates presence of asymmetry. This
may be an indication of, possible, presence of scoliosis. Otherwise, the check
shall be called negative.
Forward-Bending
Check by Parents
i) |
With back uncovered from the waist up the child stands facing the
parent, feet together. |
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ii) |
The child is asked to bend forward to reach toes with palms of hands joining
together. Knees should NOT be flexed (that is, legs should NOT be bent)
during the procedure. |
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iii) |
Child's back is now observed for symmetry of both halves of the back
from front, side and back |
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Fig. 1a-c. Forward-bending check
Visual Check by Parents
i) |
With back uncovered from the waist up,
the child stands with back towards the parent, feet together (Fig. 2). |
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ii) |
DO NOT make the child conscious that a
back examination is being done. The child may produce an artificial posture. One
way to distract the child is to pretend that you are listening to heart
sounds by placing a stethoscope on the back. |
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iii) |
Wait for a few minutes so that the tired
stage has come. |
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iv) |
Note the following (cf. Fig. 23 in the photo
gallery): a) Are the shoulder curves symmetrical? b) Are the left and the right scapula at the same level? c) Do the left and the right body triangles occupy the same area? d) Is the midline of the back straight? e) Are the spinal dimples at the same level? |
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v) |
If answer to any two of the above
questions is in the negative this check is termed as positive (cf. Fig. 2a-c). |
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Figures 2a-c. Visual
check
If any one of the above checks is positive, it is
recommended that the school physician sees the child. The child must receive a thorough,
head-to-toe examination, with the clothing removed (cf. Fig. 1 & 2).
In addition to screening for possible skeletal
deformities, this would serve as an opportunity for health education both
for the child and the parent. The child may also have to get a moiré topograph of the
back and an X ray of
the spinal column in the standing position.
Moiré fringe topography is an imaging technique, which
gives a picture of the spinal column in three dimensions, whereas an ordinary X
ray gives a picture in two dimensions only. Besides this advantage moiré fringe
topography uses only ordinary light and is, therefore, more suitable for
examination of young children, who should not be exposed to heavy doses of X
rays. In the next article
moiré technique shall be described in detail.
Appeared in the NEWS International, Karachi, Technotalk Page, March 8, 1997, 1
Updated: February 1,
2023 (0000h UTC) Next Article Printable Version PDF
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