“Abuke,” the translation for hunchback among the Yoruba speaking tribe in Southwest Nigeria, has many perceptions. Some people with this condition are treated with scorn, fear, pity, or indifference. A few of these individuals have been victims of ritual killings.
Definition: Hunchback (Scoliosis) results from abnormal growth and development of the backbones. These backbones referred to as vertebra develop while the child is in the womb. The growth and development of the backbones are normally in harmonious sequence leading to well formed bones. Sometimes, these bones fail to follow the normal growth path leading to failure of individual bones to form properly. Occasionally, backbones that are meant to be separate join together abnormally.
How soon is hunchback noticed? Some hunchbacks are noticeable at birth mostly due to the abnormal development in the womb while some are noticed as the child grows. Often, the hunchback that is noticed as a child grows is not noticed by the child but by the peers or parents who usually assume that it is from imitation of posture.
How does the disease affect the individual? The hunchback that appears before the age of 5 years causes more problem in terms of its effects on the growth of the child when compared to that which occurs after the age of 5 years.
- Among those below 5 years of age, the deformity of the back will sometimes disturb the development of the chest leading to the trapping of the lungs. With the failure of the lungs to develop properly, the ability of the body to get required oxygen to grow the organs and systems is negatively affected. This leads to their small stature. When the lungs eventually fail, early death occurs.
- In hunchback that is noticed after 5years of age, the deformity of the back may become increasingly worse but it stops after maturity or even reduces in size. Those with this type of hunchback mostly live up to old age. The major challenges in them are poor body appearance with progressive deformity that will nearly tilt them forward. There is little or no effect on their breathing capacity.
Causes of hunchback: The causes are mostly unknown. A few are due to
- Developmental anomalies before or after birth
- Tuberculosis of the spine
- Injuries to the spine.
To make a diagnosis, the child is told to bend forward to touch the toes and the deformity of the spine will be easily spotted!
Treatment of hunchback in Nigeria. Three tertiary centers in Nigeria have the capacity to treat such patients; National Orthopaedic Hospital Kano, Lagos and Enugu and few private hospitals in Nigeria located in Abuja, Kano, Lagos and probably Port-Harcourt. There are fewer treatment options in Nigeria compared to other countries. The treatment options include
- Early application of brace to either correct the hunchback or prevent its progression.
- Use of tractions, called Halo–gravity traction frame, to gradually reduce the deformity from large hunchback.
- Surgical options to correct the deformity include use of stapling, screws and rods, and hooks. This surgery can be done using camera or by opening the bones of the back through the side or back. Access through a combination of the side and back of the body to correct the deformity is also done.
Today, there are young surgeons in Nigeria who are dedicating their knowledge and life pursuit to solving the problem of hunchback. The future holds great tiding for people with the disease. The more the number of doctors that are trained to treat this condition, the more it becomes easy to advocate for government’s contribution to make quality centers available for treating this condition.
Key Recommendation: Introduction of a screening system for children in primary school through junior secondary school to detect hunchback early is essential. Such children are followed up and managed appropriately.
Dr Kawu Ahidjo MD is a registered Orthopaedic Surgeon with the Medical and Dental Council of Nigeria. He has trained specifically in Orthopaedics sub-specialties such as spinal degenerative disease, tumour, trauma, infection and deformities surgery. He is particularly interested in the surgical management of paediatric deformities and spinal trauma in Nigeria. He has extensive surgical experience in elective and emergency spine procedures. Experience was obtained from trainings in different hospitals in Europe, USA, South Africa, India and Nigeria. Notably are Schulthess Klinik, Zurich, Groote Schuur Hospital, Cape Town, UZ Gent, Belgium and New York University Hospital for Joint Diseases in US. He has a strong clinical research and audit base with a significant number of publications in peer reviewed journals (about 40 publications). He is highly interested in paediatric spine deformities and spinal cord injuries and has written extensively on these conditions. He supports medical education and is very active in creating awareness about spine and related issues in Nigeria. He works in Spinecare Hospital, Gwagwalada, Abuja. He can be contacted via firstname.lastname@example.org.