Scoliosis is a common medical condition in which a person's spinal axis has a three-dimensional deviation. Although it is a complex three-dimensional condition, on an X-ray, viewed from the rear, the spine of an individual with scoliosis can resemble an "S" or a "C", rather than a straight line.
Scoliosis is about two times more common in girls than boys and those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis.
Some severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities.
The Spine
Vertebrae. The spine is a column of small bones, or vertebrae, that support the entire upper body. The column is grouped into three sections of vertebrae:
- Cervical (C) vertebrae are the 7 spinal bones that support the neck.
- Thoracic (T) vertebrae are the 12 spinal bones that connect to the rib cage.
- Lumbar (L) vertebrae are the 5 lowest and largest bones of the spinal column. Most of the body's weight and stress falls on the lumbar vertebrae.
Scoliosis Surgery
Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 degrees to 40 degrees -- particularly if their bones are still maturing and if they have at least 2 years of growth remaining.
The goals of scoliosis surgery are threefold:
- Straighten the spine as much as possible in a safe manner.
- Balance the torso and pelvic areas.
- Maintain the correction long term.
It takes a two-part process to accomplish these goals:
- Fusing (joining together) the vertebrae along the curve.
- Supporting these fused bones with instrumentation (steel rods, hooks, and other devices) attached to the spine.
There are several approaches to scoliosis surgery, but all use modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together with existing bone.
Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused, the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.
Surgery choices
The main type of surgery for scoliosis involves attaching rods to the spine and doing a spinal fusion. Spinal fusion is used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone.
Other techniques are sometimes used, including instrumentation without fusion, which attaches devices such as metal rods to the spine to stabilize a spinal curve without fusing the spine together.
Two Approaches to Scoliosis Surgery
There are two general approaches to the scoliosis surgery - a posterior approach (from the back of the spine) and an anterior approach (from the front of the spine). Specific surgery is recommended based on the type and location of the curve.
Scoliosis Surgery from the Back (Posterior Surgical Approach) - This approach to scoliosis surgery is done through a long incision on the back of the spine (the incision goes the entire length of the thoracic spine
- After making the incision, the muscles are stripped off the spine to allow the surgeon access to the bony elements in the spine.
- The spine is then instrumented (screws are inserted) and the rods are used to reduce the amount of the curvature.
- Bone is then added (either the patient's own bone, taken from the patient's hip, or cadaver bone), inciting a reaction in which the bones in the spine begin fusing together.
- The bones continue to fuse after surgery is completed. The fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.
Scoliosis Surgery from the Front (Anterior Surgical Approach) - For curves that are mainly at the thoracolumbar junction (T12-L1), the scoliosis surgery can be done entirely as an anterior approach.
- This approach to scoliosis surgery requires an open incision and the removal of a rib (usually on the left side). Through this approach, the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies.
- The discs are removed to loosen up the spine.
- Screws are placed in the vertebral bodies and rods are put in place to reduce the curvature.
- Bone is added to the disc space (either the patient’s own bone, taken from the patient's hip, or cadaver bone), to allow the spine to begin to fuse together.
- This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.
Treating scoliosis in children
Scoliosis treatment of a child would depend on the age and the severity of his condition. There are three main treatment options:
- observation
- bracing
- surgery
Observation - Treatment for scoliosis is often unnecessary because most cases are not severe and the condition often corrects itself as the child grows. However, X-rays are needed every six months so that the progress of the curvature can be carefully monitored.
Bracing - If the curve of your child's spine is more severe (with an angle of more than 20 degrees) or it gets gradually worse, a brace will usually be required. A brace cannot cure scoliosis or correct the curve, but it can stop the curve from getting worse.
Surgery - If the curve of your child's spine is more severe (with an angle of more than 20 degrees) or it gets gradually worse, a brace will usually be required. A brace cannot cure scoliosis or correct the curve, but it can stop the curve from getting worse.
Scoliosis Rarely Causes Back Pain
It is important to note that scoliosis results in spinal deformity, but is not typically a cause of back pain. Of course, people with scoliosis can develop back pain, just as most of the adult population can develop back pain. When back pain is present with scoliosis, it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by the curve itself.
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