When is scoliosis surgery needed

Lower limb pain, a wound rupture, or infection and pneumonia are among the minor complications and side effects of surgery.

Scoliosis is serious. All surgical intervention is inherently "dangerous" and contains risks that include internal hemorrhage, stroke, blood transplants, paralysis, infection, and even death. While modern medicine has mitigated and minimized all of these risks, the risk is never zero and should be carefully considered and thoroughly discussed with one's orthopedic surgeon before committing to surgical intervention for scoliosis.

Like all conditions that may require surgical intervention, there are many individual variables patients and their parents should consider before committing to spine surgery. Most orthopedic surgeons prefer to wait unit patients are done or almost done growing as spine surgery procedures disrupt the growth plates and prevent any further growth of the spine; however, most younger children do not have enough bone density to keep the surgical hardware from pulling out of the bones potentially requiring a bone graft before the age of 10 years old.

Multiple level spine fusion surgery used for treating scoliosis massively disrupts this normal bio-mechanical process and severely limits the natural torque-producing ability of the spine. The current "hooks and screws" double steel rod surgical implants can produce excellent curve reduction in curves even as high as 90— degrees; however, this amount of forced "correction" comes with a cost. The 15—20 year follow-up studies of post-scoliosis-fusion patients with moderate-to-severe pain ranges from 40—55 percent, contrasted with a year follow-up study of completely untreated patients with scoliosis, who reported only mild-to-moderate pain the majority of the time.

Surgery is primarily indicated for cosmetic improvement of spinal deformity and potentially halting further progression. It has not been shown to consistently reduce or eliminate pain, improve cardiac heart or pulmonary lung function, or improve the patient's psychological well-being. While the majority of post-fusion patients do report satisfaction with their decision to undergo surgery, many of those respondents also report conflicting answers when answering more specific questions regarding their quality of life, suggesting a "cognitive dissonance" effect associated with their data reporting.

The decision to undergo surgical intervention is a deeply personal one, and short- and long-term considerations should be taken into account before a decision is made. The scoliosis condition appears to be primarily a neurohormonal condition with genomic variant predispositions. The spinal curve seen on x-ray is only the most obvious and visible symptom of the overall "scoliosis condition" — thus surgical intervention is only treating the condition's primary symptom and not the underlying condition itself.

As Dr. Paul Harrington inventor of the Harrington rod surgery technique used through out the s through the mid s said, "Metal does not cure the disease of scoliosis, which involves far more than just the spinal column.

Patients with fused spines have a limited range of motion in general and no motion in the areas of fusion. While it may appear most post-fusion surgery patients can and do have a normal range of motion, the motion is actually coming from the unfused segments, thereby forcing more stress, wear and tear, and premature degeneration — especially on the segments below the area of fusion, as they carry more body weight. The Scoliosis Research Society SRS currently recommends surgical intervention for patients with curves 50 degrees or more this is a degree increase from the previous recommendation for patients with curves over 40 degrees ; however, current research suggests significant lung restriction does not begin until a curve reaches 80—90 degrees.

It is one of the most extensive and invasive orthopedic procedures performed on children or adults. It involves the dissection of five layers of spinal muscles, removal of the vertebral posterior joints, and insertion of a vast system of surgical hardware. The blood loss is extensive enough to require blood transfusions, bone grafts, and a 4—6-week recovery in many cases. Long-term complications include chronic back spasms and potential metal implant toxicity from hardware breakdown leading to permanent inflammation.

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Exercises Target the Root of Scoliosis. Surgery doesn't improve breathing function. First, they prescribe physical therapy to strengthen the muscles in your core, which support your spine. Strong back muscles help to minimize your symptoms. They may also advise lifestyle changes that strengthen your core, spine, and entire body. Some recommendations include:.

They may also advise wearing a brace to help straighten your spine. They may also recommend surgical correction if you have another condition, such as spinal stenosis, that arose from your scoliosis.

Options include:. Your doctor fuses two or more vertebrae together to fix the curve and stabilize your spine. They may also place titanium screws and rods to de-rotate and straighten your spine.

To avoid another surgery, the rods and screws are left in place after your spine straightens. If your curve is severe or rigid, your surgeon may remove parts of the facet joints to release them. Congenital scoliosis results from embryological malformation of one or more vertebrae and may occur in any location of the spine.

The vertebral abnormalities cause curvature and other deformities of the spine because one area of the spinal column lengthens at a slower rate than the rest.

The geometry and location of the abnormalities determine the rate at which the scoliosis progresses in magnitude as the child grows. Because these abnormalities are present at birth, congenital scoliosis is usually detected at a younger age than idiopathic scoliosis.

Neuromuscular scoliosis encompasses scoliosis that is secondary to neurological or muscular diseases. This includes scoliosis associated with cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy and spina bifida. This type of scoliosis generally progresses more rapidly than idiopathic scoliosis and often requires surgical treatment. There are several signs that may indicate the possibility of scoliosis.

If one or more of the following signs is noticed, schedule an appointment with a doctor. In one study, about 23 percent of patients with idiopathic scoliosis presented with back pain at the time of initial diagnosis. Ten percent of these patients were found to have an underlying associated condition such as spondylolisthesis, syringomyelia, tethered cord, herniated disc or spinal tumor. If a patient with diagnosed idiopathic scoliosis has more than mild back discomfort, a thorough evaluation for another cause of pain is advised.

Due to changes in the shape and size of the thorax, idiopathic scoliosis may affect pulmonary function. Recent reports on pulmonary function testing in patients with mild to moderate idiopathic scoliosis showed diminished pulmonary function. Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI.

The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees. A positive diagnosis of scoliosis is made based on a coronal curvature measured on a posterior-anterior radiograph of greater than 10 degrees. In general, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.

A standard exam that is sometimes used by pediatricians and in grade school screenings is called the Adam's Forward Bend Test. During this test, the patient leans forward with his or her feet together and bends 90 degrees at the waist. From this angle, any asymmetry of the trunk or any abnormal spinal curvatures can easily be detected by the examiner. This is a simple initial screening test that can detect potential problems, but cannot determine accurately the exact type or severity of the deformity.

Radiographic tests are required for an accurate and positive diagnosis. Scoliosis in children is classified by age: 1.

Infantile 0 to 3 years ; 2. Juvenile 3 to 10 years ; and 3. Adolescent age 11 and older, or from onset of puberty until skeletal maturity. Idiopathic scoliosis comprises the vast majority of cases presenting during adolescence. In children with congenital scoliosis, there is a known increased incidence of other congenital abnormalities. These are most commonly associated with the spinal cord 20 percent , the genitourinary system 20 to 33 percent and the heart 10 to 15 percent.

It is important that evaluation of the neurological, genitourinary and cardiovascular systems is undertaken when congenital scoliosis is diagnosed.

Scoliosis that occurs or is diagnosed in adulthood is distinctive from childhood scoliosis, since the underlying causes and goals of treatment differ in patients who have already reached skeletal maturity. Most adults with scoliosis can be divided into the following categories: 1. Adult scoliosis patients who were surgically treated as adolescents; 2.

Adults who did not receive treatment when they were younger; and 3. Adults with a type of scoliosis called degenerative scoliosis.