Dear Readers,

Sixty three-year-old retired policeman EC writes Lifeline from Portmore, St Catherine. Mr EC has a number of medical problems, the most trying of them stemming from a recent mild stroke which occurred some two years ago.

Since then he has been experiencing breathing problems, sinus congestion, lower back pain associated with back muscle spasms which feel as if someone is "running" over his back, and insomnia.

EC is 6ft 4ins tall and used to weigh 190 pounds. Prior to his stroke, he was a very active man and he still is involved in gardening at home. He has lost a lot of weight and his weight is now down to 148 pounds. A recent X ray done by his physician has revealed that he has scoliosis. EC says he is now a very "boney" person and he would like to know what is scoliosis.

Lifeline is sorry to hear of the recent poor health which Mr EC has been keeping. He has several matters which need medical attention, not the least of which is his recent significant weight loss, which should not just be attributed to the stroke but needs to be thoroughly, medically investigated.

nerve damage

Muscle spasms of some form is a common complaint in stroke victims as the body adjusts to the nerve damage which has occurred in the brain and results in muscular weakness.

Scoliosis refers to a condition where there is a lateral (sideways) curvature of the spine. This results in a deformity of the spine, which may be temporary or permanent depending on the cause. Most people with scoliosis develop the condition in childhood or early adolescence. The cause is unknown but one side of the spine, at any level (thoracic or lumbar or a combination), grows faster than the other resulting in a curving of the spine and causing a deformity, which can be mild to severe. Management is surgical when the condition is marked and requires intervention.

Scoliosis also occurs where there are structural abnormalities in the back. Sometimes one of the spinal vertebra is abnormal such as when a hemi vertebra occurs. When there is nerve injury occurring and there is unequal muscle stimulation to the back muscles, scoliosis can also result, as occurs at times with a stroke and in persons who have suffered with polio. Here there is unequal pull to the muscles on the two sides of the trunk, which results in curvature towards the stronger side.

Sciatic scoliosis occurs due to the protective actions of the back muscles in painful spinal conditions. In many cases this is due to a prolapsed inter vertebral disc in the lumbar spine which compresses the nerve. The abnormal position occurs as the body attempts to reduce the painful pressure on the nerve.

Treatment may be medical, or surgical, or a combination. Physical therapy is often useful in reducing both pain and scoliosis in this case and anti inflammatory and muscle relaxant medications also contribute to a resolution of the condition. At times surgical decompression is necessary.

Sometimes there is a discrepancy in the length of both legs where leg lengths differ or where there is a fixed deformity of a hip joint. When these conditions occur, it is only by curving the spine to compensate for the lower limb problem that the body can be held upright. In these situations there is no spinal abnormality so the scoliosis disappears once the lower limb problem is corrected.

Mr EC could ask for referral to a private orthopaedic surgeon or to the orthopaedic clinic at any of our public hospitals to have his condition further investigated and evaluated.

Write to:

Lifeline

PO Box 1731

Kgn 8