Scoliosis and Spinal Deformity Surgery
Scoliosis is an abnormal sideways curvature of the spine. Viewed from the front or rear, a normal spine appears to be straight. When a person with scoliosis is viewed from the front or rear, the spine appears to be curved.
Common signs of scoliosis are uneven shoulders or an uneven waist. In advanced cases of scoliosis, the spine may rotate or twist, causing the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis may cause back pain and breathing difficulty.
Types & Causes of Scoliosis
There are many types of scoliosis, each having a different cause:
- Idiopathic scoliosis is the most common type of scoliosis. The cause is unknown, but there is strong evidence that it is inherited.
- Neuromuscular scoliosis results from abnormal muscles or nerves. It is frequently seen in people with spina bifida or cerebral palsy.
- Degenerative scoliosis results from bone collapse due to an injury, illness, osteoporosis, or previous back surgery.
- Congenital scoliosis is a type of birth defect that affects the development of the vertebrae. It may occur alongside other birth defects such as heart or kidney abnormalities.
About two to three percent of Americans have scoliosis at age 16. It is more common in girls than in boys.
Diagnosing Scoliosis
Abnormal spinal curvature is usually first detected by school screening exams, a child's pediatrician, or the family physician. To diagnose scoliosis, your doctor will conduct a physical examination of your spine, hips, shoulders, legs and rib cage. An X-ray is used to confirm the diagnosis and to determine the degree of spinal curvature.
Nonsurgical Treatment for Scoliosis
Adolescents with a spinal curvature of less than 20 degrees usually do not require extensive treatment. They do, however, need periodic check-ups and X-rays to make sure the curve does not get worse.
If the spinal curve is 25 to 40 degrees and the child is still growing, a 24-hour brace is often worn. Bracing is an attempt to prevent further progression of the curve, but it will not reverse or cure scoliosis.
Scoliosis Surgery
Those who have spinal curves greater than 40 to 50 degrees are often considered for scoliosis surgery. While surgery will not perfectly straighten the spine, the goal is to make sure the curve does not get worse. During scoliosis surgery, the vertebrae are fused together so the spine cannot bend. This is called a spinal fusion. The process is similar to what occurs when a broken bone heals.
Surgery begins with an incision in the middle of the back. The muscles are then moved to the side to expose the spine, and the joints between the vertebrae are removed to loosen them up. Metal implants (usually rods, screws, hooks or wires) are put in to hold the spine in place while the vertebrae gradually fuse. The procedure usually takes four to six hours, but varies from patient to patient.
The implants are left in the body, even after the bones have fused, to avoid additional surgery.
Recovery from Scoliosis Surgery
Patients usually remain hospitalized for up to one week following spinal surgery for scoliosis. During this time, physical therapists assist them with walking until they are comfortable enough to walk on their own again.
For the first two weeks after surgery, patients should not go to school or work. They need sufficient time to heal and should limit the amount of activity until they are ready.
After the operation, patients need to return to their doctor periodically for check-ups. For the first six months, they should not do any strenuous physical activity or heavy lifting. After this time, their doctor will assess their recovery and gradually increase the amount of activity allowed. About 12 months after the operation, patients should be able to engage in normal physical activities.
Spina Bifida
Spina bifida is a nervous system disorder that involves an incomplete development of the spinal cord. This condition occurs after the first month of pregnancy, which is when the spinal cord typically closes. Babies with this condition have an open area in their spinal cord, which may be caused by a combination of genetic, nutritional and environmental factors.
Many cases of spina bifida can be diagnosed while the child is still in the womb through a fetal ultrasound and other prenatal testing. Mild cases may not be detected until after the child is born, and are often diagnosed during a routine X-ray exam.
The risk of spina bifida can often be reduced by making sure the mother receives enough folic acid during pregnancy. This can often be done with prenatal vitamins and a healthy diet.
Depending on the type of spina bifida your child has, he or she may or may not need treatment. Spina bifida occulta is a mild form of the condition that does not usually cause any other health problems and leaves the spinal cord unaffected. Spina bifida manifesta, which can include a diagnosis of either meningocele or myelomeningocele, is more severe and can cause paralysis and an accumulation of fluid in the brain.
Spina bifida occulta rarely requires treatment and should just be monitored through regular doctor's visits. More severe cases may require surgery, often as soon as a day or two after birth. These surgeries push the spine back into the vertebrae and close the opening to help prevent infection and complications.
Children with spina bifida often need several surgeries throughout their life to manage problems with the feet, hips and spine, and may also need to rely on assistive devices such as braces, crutches and wheelchairs. The best treatment for your child depends on their individual condition, and can be determined by working with an experienced doctor that you trust.
Spinal Cord Injuries
A spinal cord injury is usually the result of a traumatic injury, and may be caused by:
- Falls
- Motor vehicle accidents
- Sports injuries
- Birth injuries
- Diving accidents
- Violence
The injury may result in a bruise or tear in the spinal cord and can lead to serious complications such as permanent disability and even death.
Children with a spinal cord injury may experience a variety of symptoms depending on the severity and location of their condition. Most patients initially experience symptoms of spinal shock, which causes a loss of feeling, movement and reflexes. Once this subsides, patients may then experience:
- Muscle weakness
- Loss of voluntary movement
- Breathing problems
- Loss of feeling
- Loss of bowel and bladder function
Once the spinal cord has been bruised or damaged, it cannot be repaired. Treatment instead focuses on rehabilitation to improve movement and function. Emergency surgery may be required to stabilize the spinal cord before any other treatment can be done.
A long-term rehabilitation program is often recommended for spinal cord injury patients. These programs allow your child to work one-on-one with a team of doctors, nurses, therapists and other specialists to improve muscle ability and movement. Rehabilitation programs for spinal cord injuries are often needed throughout the child's life. Parents can help their child cope with this condition through positive reinforcement and understanding.
