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Scoliosis and Spinal Deformity Surgery

Scoliosis is an abnormal sideways curvature of the spine. Viewed from the front or rear, a normal spine appears to be straight. When a person with scoliosis is viewed from the front or rear, the spine appears to be curved.

Common signs of scoliosis are uneven shoulders or an uneven waist. In advanced cases of scoliosis, the spine may rotate or twist, causing the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis may cause back pain and breathing difficulty.

Types & Causes of Scoliosis
There are many types of scoliosis, each having a different cause:

  • Idiopathic scoliosis is the most common type of scoliosis. The cause is unknown, but there is strong evidence that it is inherited.
  • Neuromuscular scoliosis results from abnormal muscles or nerves. It is frequently seen in people with spina bifida or cerebral palsy.
  • Degenerative scoliosis results from bone collapse due to an injury, illness, osteoporosis, or previous back surgery.
  • Congenital scoliosis is a type of birth defect that affects the development of the vertebrae. It may occur alongside other birth defects such as heart or kidney abnormalities.

About 2 to 3 percent of Americans have scoliosis at age 16. It is more common in girls than in boys.

Diagnosing Scoliosis
Abnormal spinal curvature is usually first detected by school screening exams, a child’s pediatrician, or the family physician. To diagnose scoliosis, your doctor will conduct a physical examination of your spine, hips, shoulders, legs, and rib cage. An X-ray is used to confirm the diagnosis and to determine the degree of spinal curvature.

Nonsurgical Treatment for Scoliosis
Adolescents with a spinal curvature of less than 20 degrees usually do not require extensive treatment. They do, however, need periodic check-ups and X-rays to make sure the curve does not get worse.

If the spinal curve is 25 to 40 degrees and the child is still growing, a 24-hour brace is often worn. Bracing is an attempt to prevent further progression of the curve, but it will not reverse or cure scoliosis.

Scoliosis Surgery
Those who have spinal curves greater than 40 to 50 degrees are often considered for scoliosis surgery. While surgery will not perfectly straighten the spine, the goal is to make sure the curve does not get worse. During scoliosis surgery, the vertebrae are fused together so the spine cannot bend. This is called a spinal fusion. The process is similar to what occurs when a broken bone heals.

Surgery begins with an incision in the middle of the back. The muscles are then moved to the side to expose the spine, and the joints between the vertebrae are removed to loosen them up. Metal implants (usually rods, screws, hooks or wires) are put in to hold the spine in place while the vertebrae gradually fuse. The procedure usually takes 4 to 6 hours, but varies from patient to patient.

The implants are left in the body, even after the bones have fused, to avoid additional surgery.

Recovery from Scoliosis Surgery
Patients usually remain hospitalized for up to one week following spinal surgery for scoliosis. During this time, physical therapists assist them with walking until they are comfortable enough to walk on their own again.

For the first two weeks after surgery, patients should not go to school or work. They need sufficient time to heal and should limit the amount of activity until they are ready.

After the operation, patients need to return to their doctor periodically for check-ups. For the first six months, they should not do any strenuous physical activity or heavy lifting. After this time, their doctor will assess their recovery and gradually increase the amount of activity allowed. About 12 months after the operation, patients should be able to engage in normal physical activities.

Potential Complications
Potential complications of spinal surgery for scoliosis include infection, bleeding, nerve damage and pseudoarthrosis. If it is anticipated that a patient will lose a significant amount of blood, the patient will be asked to donate two units of blood within the month before surgery in case there is a need of transfusion. The degree of possible nerve damage can range from a minor injury, such as slight numbness or loss of sensation, to paralysis. The risk of major neural injury is well under 1 percent. Pseudarthrosis is the term for when the vertebrae do not fuse properly. If this occurs, additional surgery may be required to replace the metal implants.

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