Spinal Deformities in India and its Treatments

A vital skeletal masterpiece by the creator, the spine or the vertebral column comprises 33 vertebras. These vertebras are simple bony structures that are compact and shaped like a marshmallow. It is the vertebral arch and body both are part of this single bone structure. It is the vertebral body that acts as a balance and bears the weight of the spine which in turn bears the weight of the upper body to a great extent. The vertebras are interlinked by a cushion, the intervertebral discs that accord great flexibility to the structure that is responsible for balancing our stance and the biomechanical movements.     

Spinal Structure & Deformities 

Much depends upon the shape of the spinal column not only for composure but also for cosmetics. While the latter does not create problems the former certainly does. A deformity results in bending and stooping and difficulty in standing erect.  

The upper spine with a greater-than-normal curve is deformed and this is called kyphosis and which can cause sagittal imbalance. Other conditions that can cause sagittal imbalance are hyperkyphosis, chin-on-chest syndrome, flatback syndrome, and ankylosing spondylitis. This type of imbalance causes stooping, and difficulty in looking ahead and if it exceeds the limit, it can compress vital organs in the chest. 

Idiopathic scoliosis  

Scoliosis happens due to side-to-side curvature of 100 either on one side (C) or on both sides (S). This is caused by adolescent idiopathic and degenerative scoliosis, neuromuscular imbalances, congenital anomalies, and tumors. Unfortunately, this can impact the heart as well as the lungs but on rare occasions. 

If interference in internal organs occurs surgical intervention may be required.  The surgery is not a cure but rather it is a correction. 

Treatment is provided if surgical intervention is not needed to alleviate pain and other systems associated with the malady.  

Corrections and Stabilization 

The main procedures are: 

• Posterior Column Osteotomy 

• Pedicle Subtraction Osteotomy

• Vertebral Column Resection

• Spinopelvic Fixation

Osteotomy creates 10 to 25 degrees of correction. This procedure removes little bone from the vertebral arch. This is useful in correcting long curves in patients suffering from kyphosis.  This operation can be performed at several levels. Very little removal of bone takes place in the osteotomy. 

More bone is removed in pedicle subtraction osteotomy than in the procedure described above. Here removal of pedicles that connect the vertebral arch to the vertebral body part which itself is removed. This procedure can be combined with osteotomy and the correction achieved is to the extent of 30deg.    

Pedicle Subtraction Osteotomy is used to correct: 

• Ankylosing spondylitis

• Flatback syndrome

• Angular kyphosis 

• C-shaped scoliosis

VCR or Vertebral Column Resection

A large portion of bone is removed in VCR much more than removal in the previous procedures described here. Implants called cages are used to replace the vertebrae. Cages are basically bone grafts used as implants. After the bone grafts heal screws and rods are used to restore stability. This procedure provides a correction of 80deg plus. 

In VCR more vertebrae can be removed to accord a greater degree of correction. 

In this procedure called Spinopelvic Fixation hardware comes into the picture. In this, screws, rods, or other elements are rigidly connecting the base of the spinal column and the bones of the hip. This procedure helps put the strain off healing bone fusion. The stress during bending and rotation betwixt the lumbar spine and the sacrum at the joint. 

Spinal surgical interventions are difficult procedures and are performed in special hospital theatres by expert surgeons. The healthy vertebrae column that is well structured needs no intervention it is when a structural anomaly develops or happens at birth then intervention is required. Surgery may not be the necessary recourse if non-surgical treatments are able to mitigate suffering. 

India has the largest cases of spinal deformities in the World. A nationwide screening takes place in the country to find out the extent every year.  

This surgery is performed in many major hospitals, especially those dealing with neurosurgery. The average cost of kyphosis or hunchback surgery in India is Rs. 374,000.00 while the cost is about USD 140000 in the USA. 

The average cost of surgical interventions in Indian hospitals ranges from Rs.180,000 to Rs.800,000 depending upon the complexity.   The cost in the country also depends upon the medical facility chosen and the city it is based in. In the metros and capital cities cost is higher than in 2-tier towns. But very few hospitals will perform complex operations related to the spine in 2 tier cities in India.  

Each of the kyphosis cases is unique and the treatments or surgical procedure varies as well. A customized plan will include various therapies before and after the operation hence the cost of cumulative procedures would rise. Physiotherapy and chiropractic care may be required in some cases the latter being an alternate healing process used in correcting mechanical disorders in musculoskeletal systems. Often home exercise with corrective bracing is prescribed post-treatment.  

Looking at the gravity of the procedures used for correcting scoliosis surgery should be the last resort. It can alter a patient’s life for good or bad.    

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