The normal human spine is not perfectly straight, but curved in the neck, chest and lower back. These curves allow us to walk upright against gravity, help to absorb stress and assist us in performing our daily activities. Our individual vertebra are able to move and twist, allowing us great flexibility to not only bend, but to do gymnastics, perfect our golf swing and other athletic feats. The human spine is truly a wonder of structural engineering.
Occasionally, something goes wrong in the formation of our spine either during development in the womb, from disease or injury causing the abnormal bone growth in the spine called Scoliosis. When we think of spinal scoliosis, we often think of an atypical curve in the spine to the right or left. However, because humans are 3-D creatures, the spine can also rotate or twist abnormally when scoliosis is present.
Most scoliosis is idiopathic in nature, meaning that the cause is unknown; however some researchers believe it is caused by a gene variant. Scoliosis can be caused by diseases, such as spina bifida, cerebral palsy or muscular dystrophy. It can also be caused by musculoskeletal anomalies, such as one leg being significantly longer than the other.
Scoliosis can be diagnosesd as early as in newborns. The good news is that Scoliosis often corrects itself as the child grows. For those kids whose curvature is more pronounced, Physical Therapy and bracing are recommended. For those rare cases where curvature is profound, pain is an issue and function is sorely compromised, surgery will be recommended. Scoliosis correction surgery for children is performed in specialty children’s hospitals which are equipped to handle the surgical needs of children.
Sometimes, scoliosis does not correct itself as the child grows into an adult. The curvature may increase despite the interventions that are tried.
Symptoms due to Scoliosis are:
- Pain
- Reduced respiratory capacity
- Musculoskeletal dysfunction
- Eventual erosion of spinal discs on one side, due to the uneven forces being placed on the vertebrae
- One shoulder may be higher than another
- Leg-length discrepancies
- Rib cage malformation
The Spine Specialists at OSC treat adults who have scoliosis with conservative and surgical modalities. Scoliosis is graded by degrees, meaning the degree of curvature of the spine compared to a normal spine on a vertical axis.
- 0-30 degrees – Mild Curvature
- 30-50 degrees – Moderate Curvature
- 50 degrees + – Severe Curvature
For those patients who have 50 degrees or less of curvature, conservative treatments are recommended. These include Physical Therapy, spine braces and medications for pain and inflammation. For those who do not respond to these treatments, epidural steroid injections, Facet Blocks or Radio frequency Ablation can be used to reduce the inflammation and pain caused by impingement on spinal nerves.
For those patients who have more than a 50 degree curvature, surgery is almost always recommended to prevent further curving, twisting or rotation of the spine. Your OSC Spine Surgeon will discuss with you how he can surgically correct your spine and which procedures are preferred. Today’s spine surgery can, in most cases, be done in a minimally-invasive fashion, resulting in less tissue trauma, blood-loss and recovery time.
Whether your surgery can be performed on an Outpatient basis or will require you to stay in the hospital will again be predicated on the severity of the scoliosis, how many regions are affected and the extent of the correction required.
The severity of the curvature and the regions of the spine affected will establish the amount of surgical correction required and the surgical approach, either anterior (front) or posterior (rear). When the surgeon accesses the spine, he will have to prepare it for stabilization by moving some of the muscles that are attached to the spine. The surgeon will then prepare the spinal bones for fusion by removing the disc, bone spurs or cartilage and filling those areas with bone graft. Instrumentation (rods, screws, cages) will be affixed to the vertebrae to straighten, align and keep them stable while the bone(s) fuse together.
Recovery time will depend on the scope of the surgery and can range anywhere from 6 weeks to 3 months. Patients will be sent home after surgery with medications to control pain and discomfort. Depending on the extent of the surgery, a Home Health nurse may come to your house to help with incision care, and to make sure you are healing appropriately, in coordination with your OSC Spine Surgeon.
You will use a brace to help support the muscles in place during recovery and will be fitted for one before your surgery. It is very important to wear your back brace as directed. You will be given lifting, bending and twisting restrictions while your bones heal. Although it is normal to need rest and modified behavior during recovery, one of the best things that you can do for yourself is to walk. Walking will help you regain your strength and help healing after surgery. Your physician will help you determine when it is appropriate for you to return to normal activities and work.
Normal human bone generates a small electric field when healing from an injury. Sometimes, this healing needs a boost, so that the bones will fuse properly. People who smoke, have had a previous failed fusion surgery or have had a multi-level fusion may have problems with their bones healing properly. A bone growth stimulator (BGS) will be prescribed to facilitate bone fusion, called union. A BGS helps bones grow by sending a small electric current through the bone, which simulates and strengthens the natural healing current. Osteogenesis- (osteo for bone, genesis for creation) then can occur. It is very important that you wear your BGS as many hours a day as your physician directs.
As with any surgery, there are risks and complications which should be considered. Surgery for scoliosis can be quite extensive, lengthy and complicated. Bleeding, infection or leakage of cerebrospinal fluid are rare. Instrumentation failure, nerve damage and paraplegia are very rare, but possible. A small percentage of patients will have wearing of the spinal discs either above or below their fused vertebra, called adjacent segment disease. This may require treatment or surgery at a later date. Non-union of the bone is also a consideration. People who take medications which deplete their calcium, are alcoholic, have osteoporosis, obesity, diabetes, renal or vascular disease are at a higher risk for non-union.
Surgery to correct scoliosis is usually quite successful and will prevent any further curvature of the spine in the operated areas. If you have scoliosis and would like a consultation, please contact us at 757-596-1900 to arrange an appointment with one of our Fellowship-trained Spine Specialists.