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Scoliosis and Deformity

Scoliosis simply means abnormal curvature of the spine. This curvature can present in many different ways and presented at different times during ones life. Babies could be born with a curvature, adolescents could develop spine curvature, or it could develop in maturity. The most common type of Scoliosis is Adolescent Idiopathic Scoliosis (AIS). The majority of this page will be devoted to AIS but we will also mention the other types as well.

Adolescent Idiopathic Scoliosis usually presents in the pre-pubertal person from about 9 years of age to about 18 years of age. Most causes for this deformity are not known and so we call this disease process idiopathic. Most schools now initiate a screening process to check for this deformity. Once detected, patients are referred to their physician for further evaluation. Physical exam and appropriate X-rays allows a trained physician to precisely measure the curvature and evaluate the patient for progression potential and plan a treatment strategy.

Great deal of research has been performed regarding the causes, diagnosis, and treatment options. Some general information is known regarding this disease. The disease is more common among girls. The younger the patient, the higher the likelihood of progression with development of larger curves. Generally, smaller curves are followed every six months and the progress of the curve is carefully measured and followed. If the curve is moderate in deformity (20-40°) consideration to bracing is given. Higher degrees of curvature are given the consideration for surgical correction.

From long term studies the medical community has concluded that patients with un-treated curvatures generally lead less active life styles, hold occupations that require less physical activities, and have more back pain episodes. For this reason, this disease is taken seriously and aggressively treated if possible. Patients with sever curves will develop deformity of their chest cavity leaving them with sever restriction in chest expansion and difficulty breathing. These patients can develop frequent respiratory infections (pneumonia), heart problems, and other related diseases as a result of scoliosis.

Careful evaluation of the patient is required prior to any surgical correction of the deformity. Curvatures are usually seen in the upper areas of the spine (thoracic), however, deformity may also be present lower back (lumbar). In fact, some curves may be present over the entire spinal column posing a difficult task for the spinal surgeon. Depending on the area of the spine with the curvature, the spine may be approach from the front or the back. Each approach has its own advantages and disadvantages. In either case, the goals of the surgery is correction of the deformity using appropriate forces and maneuvers, maintenance of the correction with metallic implants (in medical terms called instrumentation) until the bones fuse in the corrected position. Many different implants are available for use by the surgeon but these are surgeon dependent and vary widely between different centers. The choice of the implant has not been shown to make any difference in the ultimate outcome.

Advantages of front surgery include less blood loss, less levels fused, and less muscular dissection. Disadvantages of this approached have noted to be compromise of pulmonary function (since the chest cavity is entered next to the lung) and possibly some loss of correction over time. In contrast, advantages of the approach from behind include avoiding the entrance to the chest cavity and slightly better maintenance of the surgical correction. Disadvantages include the need to fuse more levels of the spine as compared with surgery from the front approach. Furthermore, more muscular dissection is required which leads to higher blood loss with the associated higher risk for blood transfusions.

Adult Scoliosis:

This disease is seen in patients after puberty where the growth of the spine has ceased. Potential for curve progression is small but patients may be suffering from back pain or the cosmetic appearance of the deformity. If the curve is seen in the young adult the most common cause is an untreated Adolescent Idiopathic Scoliosis. However, if disease is seen in the elderly patient, it is a result of degenerative disease of the spine. Treatment depends on the deformity and associated symptoms. Younger patients usually suffer from back pain and possibly leg pain. Older patients usually suffer from leg pain as the spinal cord is placed under compression by mal-alignment of the spine. Treatment depends on symptoms, degree and severity of the curvature, and the medical condition of the patient. Surgical correction is dictated by the severity of symptoms and expectations of the patient. Radiologic studies such as X-rays, MRI’s, CT scans, are used to plan tactical strategies of the surgery only. These studies do not dictate weather to operate or not, the patient’s symptoms and disability will provide much guidance to the need for surgery versus conservative treatment.

The subject of scoliosis is very broad. Much controversy is still present in the scientific community regarding etiology, diagnosis, and treatment. It is impossible to provide all information available in one page. Your orthopedic spine surgeon is able to asses your specific situation and provide you with the appropriate information to arrive at a logical treatment plan. Call our office today to set up an appointment.Scoliosis simply means abnormal curvature of the spine. This curvature can present in many different ways and presented at different times during ones life. Babies could be born with a curvature, adolescents could develop spine curvature, or it could develop in maturity. The most common type of Scoliosis is Adolescent Idiopathic Scoliosis (AIS). The majority of this page will be devoted to AIS but we will also mention the other types as well.

Adolescent Idiopathic Scoliosis usually presents in the pre-pubertal person from about 9 years of age to about 18 years of age. Most causes for this deformity are not known and so we call this disease process idiopathic. Most schools now initiate a screening process to check for this deformity. Once detected, patients are referred to their physician for further evaluation. Physical exam and appropriate X-rays allows a trained physician to precisely measure the curvature and evaluate the patient for progression potential and plan a treatment strategy.

Great deal of research has been performed regarding the causes, diagnosis, and treatment options. Some general information is known regarding this disease. The disease is more common among girls. The younger the patient, the higher the likelihood of progression with development of larger curves. Generally, smaller curves are followed every six months and the progress of the curve is carefully measured and followed. If the curve is moderate in deformity (20-40°) consideration to bracing is given. Higher degrees of curvature are given the consideration for surgical correction.

From long term studies the medical community has concluded that patients with un-treated curvatures generally lead less active life styles, hold occupations that require less physical activities, and have more back pain episodes. For this reason, this disease is taken seriously and aggressively treated if possible. Patients with sever curves will develop deformity of their chest cavity leaving them with sever restriction in chest expansion and difficulty breathing. These patients can develop frequent respiratory infections (pneumonia), heart problems, and other related diseases as a result of scoliosis.

Careful evaluation of the patient is required prior to any surgical correction of the deformity. Curvatures are usually seen in the upper areas of the spine (thoracic), however, deformity may also be present lower back (lumbar). In fact, some curves may be present over the entire spinal column posing a difficult task for the spinal surgeon. Depending on the area of the spine with the curvature, the spine may be approach from the front or the back. Each approach has its own advantages and disadvantages. In either case, the goals of the surgery is correction of the deformity using appropriate forces and maneuvers, maintenance of the correction with metallic implants (in medical terms called instrumentation) until the bones fuse in the corrected position. Many different implants are available for use by the surgeon but these are surgeon dependent and vary widely between different centers. The choice of the implant has not been shown to make any difference in the ultimate outcome.

Advantages of front surgery include less blood loss, less levels fused, and less muscular dissection. Disadvantages of this approached have noted to be compromise of pulmonary function (since the chest cavity is entered next to the lung) and possibly some loss of correction over time. In contrast, advantages of the approach from behind include avoiding the entrance to the chest cavity and slightly better maintenance of the surgical correction. Disadvantages include the need to fuse more levels of the spine as compared with surgery from the front approach. Furthermore, more muscular dissection is required which leads to higher blood loss with the associated higher risk for blood transfusions.