Spine Deformity (Scoliosis / Kyphosis)

Our Approach In Managing Spine Deformity (Scoliosis / Kyphosis)

Alignment. Balance. A Straighter Life.

 

At Shree Hospitals, we combine advanced spinal imaging, functional assessment, and world-class surgical expertise to manage spine deformity scoliosis, and kyphosis in Mumbai across all age groups and severity levels.

 

Our multidisciplinary spine deformity team approaches every case with a single guiding principle: treat the patient, not just the curve. This means factoring in age, skeletal maturity, curve magnitude and pattern, cosmetic impact, functional limitation, pain, and neurological status before recommending any course of action.

 

When a patient presents with a suspected spinal curvature, our spine specialists conduct a thorough physical examination including the Adam's Forward Bend Test, scoliometer measurement, and full neurological assessment alongside long-cassette full-spine standing X-rays.

 

This allows accurate Cobb angle measurement, curve classification, and skeletal maturity grading, all of which directly determine whether the patient needs observation, bracing, or spine deformity surgery.

 

• Full-spine standing PA and lateral X-rays for Cobb angle measurement and sagittal balance assessment
• MRI of the entire spine to rule out intraspinal anomalies (Chiari malformation, syringomyelia, tethered cord) — mandatory before any surgical planning
• CT scan with 3D reconstruction for complex, rigid, or revision deformity cases
• Pulmonary function tests (PFTs) for thoracic curves exceeding 70° to assess respiratory compromise
• Risser staging and bone age assessment for skeletal maturity determination in adolescents
• EOS low-dose biplanar imaging for radiation-minimised full-body spinal and lower limb alignment analysis

International scoliosis guidelines define clear, evidence-based thresholds for observation, bracing, and surgery based on Cobb angle and skeletal maturity (Scoliosis Research Society, 2024).

 

Our treatment decisions are aligned with these standards, ensuring every patient receives the most appropriate intervention neither undertreated nor subjected to unnecessary surgery.

 

• Patient-specific plans based on curve magnitude, location, flexibility, age, and skeletal maturity
• Bracing programmes individualised to the curve pattern and compliance factors
• Minimally invasive surgical options for eligible patients
• Intraoperative neuromonitoring (IONM) for all deformity correction procedures
• Long-term radiographic follow-up to monitor curve stability through growth and adulthood

Our spine deformity clinic runs dedicated paediatric and adult scoliosis sessions ensuring age-appropriate expertise for every patient at every stage of the condition.
 

1. Advanced Spinal Deformity Diagnosis & Assessment

 

Accurate characterisation of the spinal curve its type, magnitude, flexibility, and relationship to the patient's stage of growth is the most important step in deformity management. Our diagnostic protocols follow internationally validated standards.

 

For Scoliosis:

• Long-cassette full-spine standing PA X-ray — Cobb angle measurement, curve apex and end vertebrae identification, Nash-Moe rotation grading
• Bending films (supine lateral bending X-rays) — to assess curve flexibility and distinguish structural from compensatory curves
• Risser sign and triradiate cartilage assessment for skeletal maturity staging
• Adam's Forward Bend Test with scoliometer for rib prominence and trunk asymmetry quantification
• MRI whole spine — mandatory to exclude intraspinal pathology before bracing or surgery

For Kyphosis:

• Sagittal Cobb angle measurement on lateral standing X-ray — normal thoracic kyphosis is 20–45°; Scheuermann's kyphosis typically exceeds 45° with characteristic vertebral wedging
• Hyperextension bolster X-ray to assess curve rigidity and correctability
• MRI for disc assessment, Schmorl's nodes, and neurological risk evaluation
• Pulmonary function tests for severe curves with thoracic compromise

For Both:

• EOS biplanar low-dose imaging for full 3D spinal and pelvic alignment analysis
• CT myelography for revision or complex deformity cases
• Nerve conduction and somatosensory evoked potential (SSEP) baseline for pre-surgical neurological documentation

2. Non-Surgical Management — Observation, Bracing & Physiotherapy

 

The majority of scoliosis patients — particularly those with mild curves or those who are skeletally mature — are managed without surgery. The evidence-based decision tree is clear: observation for small curves, bracing for at-risk growing spines, surgery for curves that exceed thresholds or progress despite bracing.

 

Observation & Serial Monitoring:

• Curves under 25° in skeletally immature patients: clinical and radiographic review every 4–6 months
• Curves under 10° in skeletally mature patients: annual clinical review only
• Monitoring includes scoliometer readings, clinical photographs, and Cobb angle progression tracking

Scoliosis Bracing:

• Indicated for curves between 25–45° in skeletally immature patients (Risser 0–2) — where growth potential means progression risk is highest
• TLSO (Thoraco-Lumbar-Sacral Orthosis) / Boston Brace — the gold standard for thoracolumbar and lumbar curves; worn 16–23 hours per day
• Charleston Bending Brace — a nighttime-only brace worn in maximum lateral bending position; suitable for single lumbar or thoracolumbar curves
• Providence Brace — nighttime brace applying lateral and derotational forces; effective for specific curve patterns
• Brace effectiveness is dose-dependent — patients wearing braces >13 hours/day show significantly better outcomes (BRAIST trial, 2013)
• Digital brace temperature sensors used to objectively monitor compliance

Physiotherapy & Schroth Method:

• The Schroth Method is a scoliosis-specific physiotherapy approach using three-dimensional postural correction, breathing techniques, and curve-specific exercises to reduce rib prominence, improve posture, and potentially slow curve progression
• SEAS (Scientific Exercise Approach to Scoliosis) for patients seeking evidence-based exercise-based management
• Core stabilisation and postural awareness training to reduce back pain associated with mild-moderate curves
• Used as an adjunct to bracing — not a replacement — in growing patients

Kyphosis Conservative Management:

• Postural kyphosis (flexible, posture-driven): physiotherapy, core strengthening, and postural re-education are highly effective
• Scheuermann's kyphosis (structural, rigid): bracing in adolescents with curves 45–75° and significant growth remaining; Milwaukee or TLSO brace worn full-time
• Physiotherapy for pain management and muscle strengthening alongside bracing

3. Scoliosis Correction Surgery

 

Surgical correction of scoliosis is indicated when Cobb angle exceeds 45–50° in skeletally immature patients (despite bracing), exceeds 50° at skeletal maturity, is associated with significant pain or neurological compromise, or shows documented rapid progression. Our surgeons offer the full spectrum of modern scoliosis correction techniques.

 

Posterior Spinal Fusion (PSF) — Gold Standard:

• The most established and widely performed scoliosis correction procedure worldwide
• Pedicle screw instrumentation placed across the curve — each screw anchored through the pedicle directly into the vertebral body for three-column fixation and powerful corrective force
• Contoured rods connect the screws; compression, distraction, and derotation manoeuvres are applied to correct the curve in all three planes
• Decorticated bone and bone graft applied along the instrumented levels to achieve solid spinal fusion over 6–12 months
• Typical correction: 60–70% Cobb angle reduction with balanced, pain-free, aesthetically improved posture
• Intraoperative neuromonitoring (SSEP + MEP) mandatory throughout — any signal change triggers immediate investigation

Vertebral Body Tethering (VBT) — Motion-Preserving Alternative:

• A non-fusion, growth-modulation technique for skeletally immature patients (Risser 0–1) with flexible curves of 40–65°
• Screws are placed into the convex side of the curve via a thoracoscopic (keyhole) approach; a flexible cord (tether) is tensioned across the screws
• The tether applies asymmetric compression on the convex side of the curve, harnessing the patient's remaining growth to gradually correct the deformity — Hueter-Volkmann principle
• Preserves spinal motion at treated levels — the major advantage over fusion in young patients
• Emerging evidence supports VBT as a fusion-sparing option in carefully selected adolescent cases (SRS guidelines, 2023)

Anterior Spinal Fusion (ASF):

• Used selectively for single thoracolumbar or lumbar curves — fewer levels fused than posterior approach, preserving more motion segments below
• Disc excision and cage/bone graft placement through a lateral (retroperitoneal) approach

Minimally Invasive Scoliosis Correction:

• For adult degenerative scoliosis with mild-moderate curves and dominant pain symptoms: lateral interbody fusion (XLIF/LLIF) combined with percutaneous pedicle screw fixation
• Significantly reduced blood loss, muscle trauma, and recovery time compared to open posterior fusion

4. Kyphosis Correction Surgery

 

Surgery for kyphosis is considered when Scheuermann's kyphosis exceeds 75°, when congenital kyphosis risks neurological compromise, when adult kyphosis causes severe pain or functional limitation unresponsive to conservative measures, or in post-traumatic and post-infectious kyphosis with deformity and instability.

 

Posterior Kyphosis Correction with Instrumented Fusion:

• Pedicle screw-rod instrumentation applied across the kyphotic segment with posterior column shortening techniques (Smith-Petersen Osteotomy) to restore normal sagittal alignment
• Bone graft applied for solid posterior fusion
• Used for flexible or moderately rigid kyphotic deformities

Pedicle Subtraction Osteotomy (PSO):

• A wedge of bone is removed from a single vertebra, including the pedicles and a portion of the vertebral body, allowing the spine to "close" over the osteotomy and achieve significant sagittal correction — up to 30–35° per level
• Indicated for rigid, fixed kyphotic deformities where posterior-only column shortening is insufficient
• Technically demanding procedure requiring experienced deformity surgeons and comprehensive intraoperative neuromonitoring

Vertebral Column Resection (VCR):

• The most powerful correction technique — one or more complete vertebrae are resected and the gap is closed with instrumented correction
• Reserved for the most severe, rigid deformities (>100°) and complex congenital kyphoscoliosis
• Requires staged anterior-posterior approach in some cases

Anterior Vertebral Column Reconstruction:

• For post-infectious (Pott's disease / spinal tuberculosis) and post-traumatic kyphosis diseased or collapsed vertebrae are removed, the defect is reconstructed with an expandable cage, and posterior instrumented fusion provides stability

5. Post-Surgical Rehabilitation & Long-Term Spine Care

Recovery after spinal deformity correction surgery is a structured, monitored process not simply "waiting for the fusion to set." Our rehabilitation programme begins in hospital and continues for 12–24 months post-operatively.

In-Hospital (Days 1–5):

• Sitting and standing with physiotherapist assistance from Day 1
• Respiratory physiotherapy — particularly important for thoracic deformity correction cases
• Pain management using multimodal analgesia — minimising opioid dependence
• Brace fitting for cases requiring post-operative spinal orthosis (typically 3–6 months)
  

Early Recovery (Weeks 2–12):

• Gradual return to walking, light daily activities
• No bending, lifting, or twisting until fusion is radiographically confirmed
• Scar management and wound monitoring
• Serial clinical review at 6 weeks and 3 months
  

Intermediate Phase (Months 3–12):

• Progressive physiotherapy for core activation, postural awareness, and functional mobility
• Return to school or sedentary work typically at 4–6 weeks
• Return to non-contact sport and physical education at 6 months
• Return to contact sport or heavy physical activity at 12 months with surgeon clearance
  

Long-Term Follow-Up:

• Standing full-spine X-rays at 6 months, 1 year, 2 years, and annually thereafter
• MRI if any new neurological symptoms develop post-operatively
• Implant monitoring — hardware failure is rare but assessed at each follow-up
• Lifelong curve surveillance — adjacent segment changes monitored in fusion patients
• Psychological support available — body image concerns are common in adolescent scoliosis patients post-correction