Assala Benamara was diagnosed with congenital scoliosis when she was only four months old. By the age of 7, the condition progressed enough to cause neurological injury and made her unable to walk or feel her legs and control her bowel and bladder function.
Despite the treatment in her home country, Algeria, severe kyphoscoliosis threatened the young girl to spend her life in a wheelchair. Scoliosis is a spinal deformity that affects around 3% of adolescents. It looks like a sideward curve of the spine. When combined with an outward curvature, it forms kyphoscoliosis. While mild cases might not need any treatment, severe spinal curves that progress over time can be a disabling and life-threatening condition. If left untreated, they cause chronic pain, respiratory and cardiac problems, poor quality of life and reduced lifespan. Early detection is the key to successful and less invasive treatment, warns Professor Ahmet Alanay, an eminent specialist in orthopaedics and traumatology at Acibadem Maslak Comprehensive Spine Center. The leading institution for spine care in Turkey is committed to early detection, prevention, and advanced treatment of scoliosis. Every year in June, Acibadem marks Scoliosis Awareness Month, organizing events and providing useful information about the condition. The purpose is to increase public awareness and help parents and medical providers to understand better and recognize faster spinal deformities in children.
Scoliosis facts and myths
Most people think that scoliosis is a rare condition and the affected people are visibly hunched over. On the contrary, scoliosis is the most common spinal deformity detected in childhood. The onset is usually between 10 and 15 years of age. However, it may show up earlier or later in life. In some children, scoliosis might be inborn or related to other neurological or muscular disorders, such as cerebral palsy. In nearly 8 out of every 10 cases, the cause of scoliosis is unknown. This is usually called idiopathic scoliosis. Risk of scoliosis becomes 10 times higher for girls during puberty, says Prof. Dr Alanay. A spine deformity of 0 to 20 degrees is not noticeable from the outside, and between 20 and 40 degrees it can be noticed only on a naked body. Unlike the common belief, a straight posture is not a guarantee against scoliosis.
Home screening takes minutes but can change lives
A parent is often the first to notice when a child has one shoulder higher than the other, or see uneven waist or hips. All of these may be warning signs of scoliosis. A regular home screening can help in early detection and intervention. The home exam involves evaluation in standing and forward bend position: the child bends at the waist until the spine gets parallel to the floor. Parents should watch out for any asymmetrical parts of the lower or upper back, shoulder blades, hips, waist, or a rounded back. In a straight position with arms down, a bigger gap between one arm and the torso compared to the other side or tilted body might also be alarming. If you spot any of these symptoms, refer to a specialist as soon as possible, says Professor Alanay. Mild scoliosis cases need only medical observation, while moderate curves can be corrected through the right exercises and bracing. Without proper early measures, the risk of progression increases, and the treatment becomes more difficult.
Advanced surgical options for severe scoliosis
When the curvature develops over time and exceeds 45 degrees, it reduces the space within the chest, making it difficult for the lungs and heart to function properly. For severe scoliosis, the standard treatment is surgery involving spinal fusion. The procedure stabilizes the spine with screws and rods, and it is highly effective. Nowadays, high-tech equipment helps to improve safety and eliminates the risk of injury during spine surgery. At Acibadem, spinal navigation and neuromonitoring enhance the safety and success rates of spinal operations.
For a specific group of scoliosis patients, an innovative surgery called Vertebral Body Tethering (VBT) can be an alternative to spinal fusion. This is a highly advanced procedure performed by a handful of medical teams worldwide. Preserved spinal flexibility while the spine keeps growing and a shorter recovery period are strong advantages of VBT. After the minimally invasive procedure, the child can go back to school within a week or two and engage in all types of sports 3 months later. The spinal deformity is partially corrected during the surgery, and spontaneous correction continues over time, with the patient’s growth. The Acibadem Maslak Comprehensive Spine Center was the first one to apply the new method outside of the USA, where it was first invented. During the last 7 years, more than 100 patients have been successfully treated with Vertebral Body Tethering at Acibadem, which makes it one of the most experienced centres around the world.
Amazing results and a better future for scoliosis patients
7-year-old Assala, who was about to stay immobile due to severe kyphoscoliosis and had exhausted the treatment options in her home country, was brought to Acibadem Hospitals in Turkey by her family. “I researched the advantages of the Acibadem hospital on the social media sites, on the internet, but when I came here and I had my first-hand experience with the hospital, I was very surprised by the warm welcome and the expert medical care this hospital offers to patients from all over the world,” says Assala’s father, Fodel Benamara, who is a primary education teacher.
Actually, Assala had two serious problems at the same time: severe spinal deformities and significant loss of neurological functions. “We had to react quickly and do a surgery to decompress her spinal cord and relieve it, which might hopefully end up with recovery in her neurological function and make her able to walk again,” explains the spinal surgeon Professor Ahmet Alanay. The medical team experienced in complex cases planned a high-risk surgery in two stages. As a first step, three deformed vertebrae were removed to ease the pressure on the spinal cord and replaced by a cage. Three days later, the surgery was completed by full correction of the deformity. After the operation, Assala had a quick recovery of neurological functions: she could feel her body again and was able to move the fingers, knees and hips of her legs. “Having all these functions back in a very short period gave us big hope about her future. We believe that with good rehabilitation, she will be able to walk again,” Prof. Alanay commented. In order to preserve the fixation, the girl will have to wear a halo brace for a period of 3 to 6 months. After 6 weeks of the surgery, Assala came walking to her follow-up control.
Assala’s father, Fodel Benamara, is now optimistic about the future: “Assala’s condition has improved and, in fact, I am amazed by the result. There is an improvement and all doctors agree that we’ll see bigger improvement as the rehabilitation continues and with daily exercise for some time. God willing, the future will be better, better than now.