Scoliosis is the abnormal curvature of the spine giving the spine an “S” or “C” shape. Scoliosis can occur at any age and is more common in girls than boys. Larger curves cause discomfort while the smaller curves do not cause any problems. In most cases, the exact cause remains unknown.
Scoliosis is categorized into four major types based on the age of onset, cause, and spinal curvature. They include:
- Structural scoliosis
- Non-structural scoliosis
- Idiopathic scoliosis
- Infantile scoliosis
- Juvenile scoliosis
- Adolescent scoliosis
Other types include neuromuscular, congenital, and degenerative scoliosis.
Based on the type of scoliosis, age of the patient, and severity of curvature the surgeons recommend either non-surgical or surgical treatment. Non-surgical treatment includes periodical observation at 4 to 6 months intervals. If the curve is mild and the patient has balanced patterns of malformation, it requires no treatment. The doctor will observe these changes by X-rays taken during the period of rapid growth. Braces or casts are used to control the compensatory curves that are adjacent to the congenital abnormality of the vertebra to prevent them from worsening.
Surgical options
Spinal fusion: It involves the removal of the abnormal vertebra and the replacement of vertebrae with bone grafts. Two or more vertebrae are fused together with the help of bone grafts and internal fixators such as metal rods, wires, hooks, or screws are used to form one single bone. These internal fixators help to stabilize the fusion and partially help to straighten the spine. After the surgery, patients must wear a cast or splint to help the healing process.
Hemivertebra removal: In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed and the vertebrae present above and below the hemivertebrae are fused together with the help of metal screws. This procedure helps to straighten the spine and allows the adjacent portion of the spine to grow normally. After the surgery, patients must wear a cast or splint to prevent mobilization and bring about the fusion of vertebra.
Growth rod insertion: Spinal fusion surgery will not be effective in a growing child and may cause impairment of the chest and growth of the lungs. Therefore, before going for surgery, doctors recommend a procedure involving the insertion of growth rods. One or two rods will be attached to the spine above and below the curve allowing the spine to grow while correcting the curvature. These rods will be left in place until the child is completely grown after which spinal fusion surgery will be performed.
Reconstructive osteotomy and instrumentation: This procedure is done if spine deformity in children causes breathing problems, pain, and risk to the spinal cord or impairment of the torso shape. In such cases, the osteotomy is done to remove part of the vertebral column and then followed by insertion of internal fixators such as metal rods, hooks, screws, and wires to restore the balance of the spine.
Physical therapy: Doctors advise physical therapy after the surgery to help the spine grow normally. Physiotherapists evaluate the posture, muscle strength, and flexibility and then design an exercise program suitable for the patient that helps to control pain and improve the disability.
What is Adult Scoliosis?
Adult scoliosis is the abnormal curvature of the spine giving the spine an “S” or “C” shape in a skeletally mature person. Larger curves cause discomfort while smaller curves usually do not cause any problems. In most cases, the exact cause remains unknown. However, adult scoliosis can develop as a result of:
- Untreated childhood scoliosis
- Inherent, age-related changes occurring in the body
- Certain diseases affecting the spine
What are the Symptoms of Adult Scoliosis?
Scoliosis can lead to physical deformities such as humpback, prominence of the ribs, uneven shoulders, tilting of the trunk to one side and head, not in the center position. It also causes altered gait, spinal instability and rigidity. Pain is the predominant symptom in patients suffering from scoliosis. A compression of the spinal nerve root can result in lower limb weakness along with numbness or tingling sensation. This may hamper coordination and balance with difficulty in movement, standing or sitting. Occasionally, compression of the lower spinal nerves can also lead to difficulty in urination and defecation. This requires immediate medical care. In severe cases, lung and heart (cardiopulmonary) function can be affected.
How is Adult Scoliosis Diagnosed?
A diagnosis of adult degenerative scoliosis involves:
- A detailed medical and family history of the patient
- Neurological examination with testing of reflexes to evaluate muscle weakness, sensitivity, and other signs of neurological injury
- Physical examination to evaluate movements at the spine and leg length measurements
Diagnostic imaging techniques such as X-rays, CT scans, MRI scans and myelography, may also be used to improve the accuracy of diagnosis.
What are the Treatment Options?
Non-surgical treatment
Most patients with adult scoliosis do not require surgery. Non-surgical treatment includes analgesics and anti-inflammatory medications, braces, spinal injections, and physical therapy. Simple lifestyle modifications such as improved nutrition, smoking cessation and regular exercise may also help in the management of scoliosis.
Surgical treatment
Surgery is recommended for patients who fail to respond to non-surgical treatment or the curvature progresses and becomes greater than 45-degrees, or cardiopulmonary complications occur.
The surgery repairs the abnormal curvature of the spine and stops the curve from getting worse. The surgery utilizes rods, bars, wires, screws, and other types of medically designed hardware to straighten the spine. These are fixed to the vertebrae involved in the curve and the correction is performed. Removal of the intervertebral disc (discectomy) and fusion of the involved vertebrae may also be performed during the surgery. Fusion fuses the involved vertebrae permanently into a single solid bone by placing bone grafts or bone graft substitutes in between the affected vertebrae.
There are different surgical approaches to repair the spinal deformity. The choice of the approach depends on the type of scoliosis, location of the curvature of the spine, ease of approach to the area of the curve and the preference of the surgeon. Adult Scoliosis correction surgery is relatively safe and usually provides excellent results
What are the Associated Risks and Complications?
Possible complications after scoliosis repair surgery may include:
- Nerve damage causing muscle weakness
- Respiratory or lung problems causing difficulty in breathing
- Spine infection
- Failure of the bone to join together
- Blood loss requiring transfusion
- Blockage of the intestine may occur
- Gallstones may occur
- Movement of the metal hooks placed in the spine
- Pseudarthrosis, a painful condition occurring as a result of non-healing of the bone effusion, and a false joint grows at the site
- Blood clot formation in the legs, a rare but dangerous condition if the clots dislodge and travel up to the lungs. (pulmonary embolism)
- Pain at the bone graft site
Physical therapy is advised after surgery to evaluate posture, muscle strength, and flexibility and design an exercise program suitable for the patient that helps to control pain and improve the disability.