A scoliosis is defined as a curve to the normal straight alignment to the spine when looked at from behind. The vast majority of individuals who develop a scoliosis will suffer no spinal pain at all and many are not aware that they even have a scoliosis. As the curve develops a further curve compensates to balance the spine and as such a scoliosis is always in essence to curves in an S shape. For some adolescent
An idiopathic scoliosis is when the scoliosis develops during adolescence with no cause identified. This is the most common form of scoliosis.
A degenerative scoliosis occurs when the spine develops a curve due to degenerative (age related) changes to several of the joints of the spine. Degenerative scoliosis tend to be focused in the lower (lumbar) spine where as idiopathic scoliosis are often focused in the middle (thoracic) spine.
Thirdly, a scoliosis may develop due to an underlying medical condition. Examples may include neurological disorders such as cerebral palsy causing an individual to suffer with a neuro-muscular scoliosis. The cause in this instance is probably due to the muscles of the trunk having less control and being inherently weaker allowing the spine to curve.
The majority of idiopathic scoliosis are mild and stop their progression before there is any significant problems from a cosmetic or balance perspective. Circle Health can offer courses of physiotherapy with our expert spinal physiotherapists which may further help mild and non-progressive cases of scoliosis. Physiotherapy treatment can help in a number of ways:
- Spinal mobilisation to keep the affected areas of the spine (lumbar and thoracic areas) flexible
- Strengthening the muscles which help to support an upright spinal posture
- Ergonomic advice especially for individuals who work long hours at a pc
- Advice on safe and effective stretching program for the hips and shoulders as flexibility at these areas can be key in compensating for a mild scoliosis
In cases where idiopathic, degenerative or neuro-muscular scoliosis are deemed to be progressing, they are leading to significant cosmetic issues, or in rare cases they progress to the point where internal organs are being compromised, surgery may be considered.
Although there are new surgical techniques which aim to correct the curvature of an adolescent scoliosis by placing pressure on the opposite side of the curve these methods are rarely used. Normally, the surgery of choice will be a scoliosis correction and spinal fusion operation.
A spinal fusion operation to re-rotate a scoliosis is rarely done from an anterior (from the front) approach and is more often performed with a posterior (from behind) approach. Due to the nature of the surgery the surgeon will carefully plan which levels are to be fused and how and this will determine the approach used.
This procedure is carried out by Circle Health’s experienced spinal consultants and is carried out under general anaesthetic. Typically, the fusion will have to be done over several levels of the spine and once the patient is anaesthetised the surgeon will use x-rays to identify the spinal alignment and levels to be fused before making the incision.
To access the relevant levels of the spine accurately, the surgeon will carefully make the mark the areas of the skin and then make the incision.
Depending on which approach is used and which levels of the spine are being accessed the surgeon will carefully retract the subcutaneous tissue as well as any muscles or rib cage that would otherwise impede access to the spinal column.
Once the spinal column is accessed the surgeon will place a monitoring system on the spinal cord and legs which detects any early changes to the spinal cord’s function. This is needed to ensure that when the spinal column is de-rotated to correct the scoliosis the spinal cord is not damaged.
Next, the spinal surgeon will attach screws to parts of the vertebrae throughout the levels to be corrected and place hooks or rods through these screws. Once achieved, the surgeon is able to tighten the screws to de-rotate the spine to a more neutral alignment.
Bone graft will also be placed throughout the levels to be fused to add even more strength to the new spinal alignment.
There are some specific risks associated with scoliosis fusion surgery. These will be discussed in detail with you by your surgeon prior to your operation and can include:
- Infection is one of the biggest concerns following scoliosis fusion surgery. Due to the nature of the surgery needing large incisions to access the spinal column adequately patients undergoing these types of fusion surgery will always be routinely treated with anti-biotics for 7-14 days. Although, infection is a risk our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
- Failure to fuse at the operated level
- Persistent pain at the site of the bone graft (normally the iliac bone at the pelvis)
- Progression of spinal disease especially at the adjacent spinal joints which may have increased loads and movement placed on them due to the fusion
Some general complications of lumbar spine surgery which affect a very small percentage of patients can include:
- Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
- Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
- In rare circumstances patients, may suffer a stroke as a result of a blood clot developing.
- Damage to the nerves in the lumbar spine which may result in sensory loss and weakness in the legs and in extreme circumstances loss of bladder/ bowel/ sexual function.
- The intended benefits of reduced pain and increased function may not be felt.
If a scoliosis is treated with physiotherapy the aim of treatment is to stabilise the progression of symptoms and improve function. A course of physiotherapy may last between 6 to 12 weeks.
If surgery has been undertaken, patient’s will be instructed to avoid any twisting, bending or lifting with the spine for the first 2 weeks. Antibiotic treatment will be given during this period to guard against any infection.
Depending on the exact fusion achieved, patients will then be instructed to return to a sensible, independent standard of living at home ensuring they do not push their activities too much too early. Walking around the house and up to two miles per day outside are sensible activities.
Patients are normally instructed to ensure not to stay in one position for too long i.e. prolonged sitting or standing may increase pain levels during the initial period of time after a spinal operation. Any weight lifted during the initial 6-12 weeks should weigh no more than a kettle.
Once patients have overcome any acute post surgical pain and the surgeon is happy with check xrays and general recovery, Circle Health’s spinal physiotherapists can advise regarding ongoing:
- Increase strength in your spine
- Increase balance and co-ordination
- Where necessary prepare you for a return to sports and other higher level activities.