Scoliosis
Scoliosis is a condition characterized by the sideways curvature of the spine, forming an “S” or “C” shape. While a normal spine extends straight up and down, a scoliotic spine typically shows a curve that deviates in the opposite direction. This condition often develops during childhood or adolescence and can progress rapidly during growth spurts. The cause of scoliosis is often unknown (referred to as idiopathic scoliosis), but it can sometimes be caused by neurological disorders, muscle diseases, genetic conditions, or congenital abnormalities of the spine.
What are the Symptoms of Scoliosis?
Mild scoliosis often doesn’t cause any symptoms and is frequently detected incidentally. In more severe cases of scoliosis, symptoms become more noticeable. These may include significant shoulder height difference, one side of the waist appearing more prominent than the other, one hip being higher than the other, and a constant feeling of fatigue.
If scoliosis progresses and starts exerting pressure on the spinal cord, it can cause pain and, in some cases, difficulty breathing.
How is Scoliosis Diagnosed?
The diagnosis of scoliosis is typically made by a healthcare professional through a physical examination and X-ray imaging. During the physical examination, the doctor assesses the patient’s shoulders, waist, hips, and ribcage. X-rays help the doctor determine the degree and location of the spinal curvature. Additionally, the doctor may use a measurement method called the Cobb angle to determine the degree of curvature.
What are the Surgical Treatment Options?
In severe cases of scoliosis or when the curvature of the spine progresses rapidly, surgical treatment may be recommended. Scoliosis surgery typically involves the placement of metal rods, screws, and plates. This helps to straighten and stabilize the spine. After surgery, these rods and screws are typically left in place to continue stabilizing the spine.
Posterior Approach: This is the most commonly used surgical method for the treatment of idiopathic scoliosis seen in young people. During the procedure, the spine is corrected with rigid rods, and then spinal fusion is performed. In spinal fusion, a bone graft is added to the curved area of the spine, creating a fusion between two or more vertebrae. While spinal fusion takes place, the metal rods attached to the spine help keep it straight. This procedure typically takes a few hours in children but may take longer in older adults. With advancements in technology, most individuals with idiopathic scoliosis are discharged within a week after the surgery and do not require post-operative bracing. Most patients can return to school or work two to four weeks after the operation and can resume pre-operative activities within four to six months.
Anterior Approach: The patient lies on their side during the operation. Thoracoscopic video-assisted thoracoscopic surgery (VATS) allows for better visualization of the spine and requires fewer incisions than an open procedure. Potential advantages of the anterior spinal approach include greater degree of correction, faster rehabilitation, improved spinal mobilization, and fewer fused segments. Potential disadvantages include the need for bracing for many patients until several months after the surgery and higher morbidity risk with this approach, although VATS reduces this risk.
Decompressive Laminectomy: The roof portion of the spine, known as the laminae, is removed to create more space for the nerves. In cases where scoliosis and spinal stenosis coexist, spinal fusion and/or spinal instrumentation are usually recommended. Various instruments (screws or rods) may be used to strengthen fusion and support unstable areas of the spine.
Minimal Invasive Surgery (MIS): Fusion can sometimes be performed through smaller incisions using MIS. Advanced fluoroscopy (X-ray imaging during surgery) and endoscopy (camera technology) facilitate more accurate incision placement and hardware placement, minimizing tissue damage. However, this method may not be suitable for every patient.
What Should Patients Expect from Surgery?
Surgical treatment typically significantly improves the appearance of the spine and reduces pain. However, patients should understand that the recovery process takes time and that physical therapy is usually a significant part of the post-operative period. Physical therapy helps patients return to their daily lives while maintaining the positive outcomes of the surgery.
What are the Risks of Surgical Treatment?
Like all surgical procedures, scoliosis surgery carries certain risks. These may include infection, bleeding, nerve damage, and the possibility that the surgery may not have the desired outcome. While these risks are rare, they are possible. Therefore, patients should have detailed discussions with their doctors about treatment options and expectations and make their decisions based on this information.