Scoliosis treatment

What is Scoliosis?

Scoliosis is an abnormal sideways (lateral) curvature of the spine. The spinal column (backbone) of the patient with this condition curves and twists, so rotating the ribcage. X-rays of individuals with scoliosis show an ‘S’ or a ‘C’ shaped curve rather than a straight line. Scoliosis can be disfiguring and often presents with a hump. Scoliosis affects approximately 2% of the population to some degree but serious noticeable curves are much less common. (see Fig. 1).

How is scoliosis managed?

Scoliosis is managed according to the presenting factors. For small curves, we start with exercise and regular monitoring. If during monitoring, an increasing curve occurs before or during puberty, then the consultant may advise a spinal brace. Even with regular exercise, monitoring and regular use of braces, some patients whose curves keep progressing may be referred for surgery.

What is done during surgery?

Surgical treatment usually combines correction and straightening of the curvature and deformity with implanted rods and fusion of the involved vertebrae. This means that the levels fused act as one column of bone. Operations for scoliosis can be carried out from the front (anterior) or the back (posterior).

Patients with more severe curvatures might need both an anterior and posterior approach performed. In the hands of a skilled surgeon, neither approach is clearly superior. The consultant will advise you which surgical approach would be most appropriate. Scarring is kept to the minimal for most patients. Invisible sutures are used internally that dissolve and sterri strip plasters are used for the skin.

What are the risks of surgery?

Surgery in an adult carries a higher rate of complications and risks than in a child or teenager. Immediate risks of surgery include:

• Neurological complications; this is the loss of movement in all extremities or just partial loss of function. Neurological complications are rare, but they can occur. To reduce the risk, intraoperative electronic monitoring of spinal cord functioning is used.
• Infection; deep wound infections are rare but may require further surgery.
• Surface infections are more common and need wound care and antibiotics.
• Lung problems; collapse of small portion of the lung is a common cause of fever after surgery. Frequent turning of the patient by the nurses and physiotherapists using techniques to encourage deep breathing and coughing help prevent this. 
• Ileus (lazy bowel) is a common complication after spinal fusion. To treat this complication, the patient is not allowed to have any food and drink by mouth until the signs of normal bowel function returns, which is usually within three days after surgery.
• Temperature change in the foot, leg because of operation e.g. one foot cold and one foot warm as nerves has been disturbed or severed.
• Numbness in vicinity of operation site, sensation may return after time.  

How flexible will I be after surgery?

This depends largely on how many vertebrae are fused, and where in the back these vertebrae are located. Fusing just the middle of the back (the thoracic vertebrae) will not significantly impact the forward bending flexibility, since these vertebrae connect to the ribcage which is fairly rigid anyway.

Fusing the upper back and neck (the cervical region) will limit the bending and twisting flexibility in your neck somewhat, but usually not severely.

The five lumbar vertebrae at the base of the spine are the most important for bending; flexibility and when these are affected by the surgery noticeable stiffness will result. The aim of the surgery is to stabilise the spine by fixing as few vertebrae as possible.