Scoliosis is a curvature of the spine. It usually affects young children and adolescents. It can also occur in elderly patients and this is often referred to as degenerative scoliosis and is usually due to the wear and tear of the disc. It is often classified by cause i.e. idiopathic, congenital, neuromuscular or syndrome related. Idiopathic scoliosis is by far the most common and it is a diagnosis by exclusion.
Cause of scoliosis
The aetiology of scoliosis remains unknown but there are several factors which may contribute to the cause, which are mainly genetic factors, related to disorders of bone, muscles and disc, growth abnormalities and central nervous causes.
It is important to consider patient with scoliosis as a patient with a sign (rather than a diagnosis). Most scoliosis (approximately 80%) is idiopathic i.e. no known cause. The remaining incidences are associated with a wide variety of disorders, of which scoliosis is often the presenting complaint.
Symptoms of scoliosis
Most adolescents are concerned about the cosmetic appearance of their spine. It is not uncommon for a scoliosis to be discovered after many years. Most patients complain of a prominent rib hump, which is associated with rotation of the vertebra. Patients may also complain of pain.
Most patients have a plain x-ray of their spine. Clinicians often measure the severity of the curve by measuring the Cobb angle.
If there are any concerns about the aetiology of the scoliosis and an MRI scan is indicated this can sometimes show abnormality within the spinal cord, which may be contributing to the scoliosis. Certainly all patients who require an operation will have a pre-operative MRI scan.
Non-Surgical treatment: Most patients with idiopathic scoliosis have a curve of less than 20° and only a small percentage progress and therefore most patients just require reassure and regular monitoring to ensure that the curve does not progress. If the curve is less than 20°, the child is closely monitored every 6 months. However if the curve is progressing particularly during rapid periods of growth then one may need to consider brace treatment.
Indications of brace treatment: Spinal orthosis is recommended in a curve between 25-30°. We tend to use the Boston brace (see example). A brace will not correct a scoliosis but will prevent progression.
Surgical correction: If a curve is over 40° it is likely that a curve will progress by 0.5-1° a year after skeletal maturity. It is easier to correct these curves at a younger age as opposed to when the patient is older as the deformity often becomes fixed. The exact mechanism of the correction is usually based on the type of curve and the location.
The main risk of which you should be aware, is the possibility of damage to the spinal cord. If this happens it can result in paralysis of the legs and loss of control of the bowels and bladder. This complication is rare and world-wide it occurs in about 0.5% of cases.
Special precautions are taken to protect the spinal cord. In particular spinal cord monitoring is used so that if anything damages the spinal cord during the operation, it can be detected immediately and hopefully the situation remedied.
The other risks are those which exist with any big operation. These include damage to important blood vessels, particularly if the operation is done through the chest. Damage to one of the main blood vessels near the spine could result in life-threatening bleeding.
Wound infections can occur and these sometimes do not become apparent until several months or even years later. If this occurs then it may be necessary to remove the metalwork from the spine.
There will always be a large scar on the back or round the side of the chest which may be a bit unsightly, though it fades with time. Sometimes the skin around the scar can feel numb or tender.
Treatment after the Operation
After the operation, assuming that everything goes well, you will probably be looked after on the High Dependency ward overnight and you may be kept anaesthetised with a tube down the throat. There will also be a variety of wound drainage tubes and a tube in the bladder. You will then be transferred back to the normal ward the following day. The various tubes will be removed over the course of the next few days.
It should be possible for you to get out of bed after 4 or 5 days and then gradually get more mobile on the ward. It may be necessary for a spinal brace to be worn for a few weeks. Patients are normally ready to leave hospital about two weeks after their surgery.
After discharge from hospital you should be able to do all everyday activities at home and should be able to return to school after four to eight weeks. It takes a few months for the intervertebral fusion to take place and the spine has to be considered somewhat weaker than normal until it is fused. She/he should be able to finally resume all everyday activities after about 6 months and sport after a year.