What is Scoliosis?
The abnormal curving of the spine is known as scoliosis. If you take a look at the image of any back, you will see it has a natural curve to it. The difference with the backbone of a patient with scoliosis is that there is excessive spinal curving. Before puberty, usually between the ages of 9 to 15, there is a growth spurt, and this is typically the time that scoliosis develops. The majority of cases are idiopathic where the cause is unknown. However, it can also be congenital, hereditary, or as a result of an underlying neuromuscular condition such as cerebral palsy or muscular dystrophy. While scoliosis develops in both males and females, those cases found in the female population are more likely to require treatment.
The symptoms can vary dependent on the severity of the spinal curve. In mild cases, there may be no apparent symptoms apart from the irregularity of the spines appearance. In worse cases, such as those where the spine twists, patients may experience, and in severe cases may require treatment. Symptoms of scoliosis include:
- Lower back pain
- Extreme fatigue
- Difficulty breathing
What Are The Different Types Of Scoliosis?
Several types are commonly seen:
- Infantile Scoliosis occurs in children less than 3 years of age and is most commonly associated with other serious congenital or neurodegenerative disorders like cerebral palsy, tethered spinal cord, and myelomeningoceles, among others. Surgery is sometimes necessary, but often non-operative techniques are used to allow for spinal growth prior to a spinal fusion procedure.
- Juvenile Scoliosis occurs in the 3 to 10 year age group. These deformities tend to be progressive as children grow in more than half of cases. Bracing is often used as an initial treatment until the child grows sufficiently and reaches an age and body size suitable to appropriate surgical correction. In the more severe cases, surgery is performed before adolescence.
- Adolescent Idiopathic Scoliosis is the most common form of scoliosis, occurring in the 10 – 17-year-old patients. There is no identifiable cause for this disorder, and it varies greatly in it symptoms and severity. Decisions for treatment are based on the severity of the curvature, and the progression or worsening of the curvature. This condition is typically not painful, except in the most severe cases and not associated with neurologic deficits including lower extremity weakness or numbness. The majority of these conditions occur in the thoracic spine, below the neck and above the low back region. Scoliosis that was thought to be stable during adolescence and young adult life may worsen with the appearance of degenerative arthritis. This Neglected or Decompensated Scoliosis may become severely symptomatic in later adult life.
- Adult Degenerative Scoliosis is an increasingly more common form of scoliosis which appears in adult life along with the onset of degenerative arthritis in the lumbar spine. These patients did not have Scoliosis as children. It worsens with age and is often associated with pain and nerve compression from spinal stenosis.
The surgery for correction of scoliosis in adults typically is much longer and much more involved than surgery in adolescents or children and may take anywhere from six to twelve hours. As part of the surgery, occasionally it is necessary to remove part of the bone and performed so-called osteotomy to improve surgical correction. Another part of the procedure is the placement of instrumentation or pedicle screws; this frequently is done with the assistance of robotic guidance or fluoroscopic guidance.
The next part of the surgery involves placements of the rods and corrective maneuvers. At times, decompression of the neural elements (spinal cord or nerve roots) is required. After the surgery, patients at times need to go to the intensive care unit. The hospital stay after surgical correction of spinal deformity can be anywhere from three to ten days. Postoperative bracing sometimes is required.