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Scoliosis Surgery

Scoliosis is a neuromuscular condition which causes the curving of the spine to the side and the most common part of spine affected by scoliosis are thoracic scoliosis (chest area) and lumbar scoliosis (lower section of the back). Patients with scoliosis have forward head posture due to the curve in their necks. The sideways curve of scoliosis spine is more than 10 degrees and causes twist in the ribcage and flatten the normal curve of the spine. Most often scoliosis occurs in children age 10 to 15 (mostly girls) and they develop spine deformities during their growing years. This condition is progressive in most cases. Children with a mild scoliosis are monitored closely with the help of X-rays to check if the curve is getting worse and if they need to wear a brace to stop the curve from worsening whereas in some cases, surgery may be required to correct the deformity. Some of the symptoms of scoliosis are:

• Uneven shoulders

• One shoulder blade appears more prominent than the other

• Uneven waistline

• Uneven hipline

• Forward head posture

• Curvature spine

There are mainly four types of scoliosis:

1. Idiopathic scoliosis – when the exact cause of scoliosis is unknown it is called idiopathic scoliosis. This can be described on the basis of age of the children like infantile idiopathic scoliosis (less than 3 years), juvenile idiopathic scoliosis (age 3 to 10 years), adolescent idiopathic scoliosis (children between 10 to 18 years) or adult idiopathic scoliosis (people above 18 years).

2. Functional scoliosis – when spine is normal but an abnormal curve develops in any other part of the body. This could be caused by one leg shorter than other or by muscle spasms in the back.

3. Neuromuscular idiopathic scoliosis – developed in children who have neuromuscular disorders like muscular dystrophy or cerebral palsy. People develop a long C-shaped curve and weak muscles that cannot hold them up straight. The curve present at birth is known as congenital scoliosis. This needs more aggressive treatment than other types of scoliosis.

4. Degenerative idiopathic scoliosis – this occurs in older adults and caused by changes in the spine due to spondylosis (arthritis), osteoporosis, and vertebral compression fracture and disc degeneration.

Mostly people with scoliosis have mild disorder but sometimes it can cause few risks and complications that may include:

• Damage to lung and heart – due to severe scoliosis, the rib cage presses against the lungs and heart makes it more difficult to breathe and harder for the heart to pump.

• Back problems – scoliosis in adults are more likely to have chronic back pain than people in the general population.

• Appearance - scoliosis can cause more noticeable changes upon worsening such as unlevel shoulders, prominent ribs, uneven hips, uneven waist and trunk to the side. People suffering from scoliosis often become self-conscious about their looks.

Doctor may require to perform imaging tests like X-rays, MRI or CT scans including some other tests such as medical history of the patient, physical examination (bending forward from the waist with arms hanging loosely to check if the ribcage is more prominent than the other), neurological examinations (for muscle weakness, numbness, or abnormal reflexes).

Patient who has scoliosis with mild curves may not need treatment with a brace or surgery but may require regular checkups to see if there have been changes in the curvature of their spines. Treatment of scoliosis depends on an individual basis and factors like severity of curve, curve pattern, location of curve or maturity. Doctor may recommend a brace in case the bone of child is still in the growing phase or has moderate scoliosis. It won't cure scoliosis or reverse the curve, but it usually prevents further progression of the curve. Plastic brace is the most common type of brace that contoured to conform to the body. The brace is closely fitted and almost look invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips. Most braces can be worn day and night as it increases its effectiveness. Children with brace can participate in almost any activity without many restrictions. Braces can be removed when the bones stops growing.

Severe scoliosis generally progresses with time so doctor may suggest scoliosis surgery that aims mainly at stopping the curve’s progression, reduce the deformity and maintain trunk balance. Spinal fusion is the most common type of scoliosis surgery. In this procedure, surgeons connect two or more bones in the spine together so they can't move independently. Bone pieces or special material look like bone are placed between the vertebrae. With the support of metal rods, hooks, screws, the spine will be kept straight while the old and new bone material fuses together. When scoliosis is progressing rapidly at a young age, a rod that can be adjusted in length is installed to the top and bottom area of the spinal curvature and can be lengthened every six months. Physical therapy and general exercise is recommended after the surgery to improve the overall health of the patient.

Some of the risk and complications of scoliosis surgery include:

• Bleeding

• Pain

• Nerve damage

• Blood clots

• Lung complications

• Pain at graft site

• Pseudarthrosis

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