What is Scoliosis?
Scoliosis is a deformity of the spine that has long been associated with children. The truth of the matter, however, is that the condition can develop at almost any age. In scoliosis rather than presenting as a straight up and down column, the spine assumes a lateral “S” shape when viewed from the rear.
The scoliosis is classified as either congenital or idiopathic. In cases of congenital scoliosis, there are defects in the vertebrae of the spinal column present at birth. Idiopathic in medical terms means that the cause is not known and the condition arises spontaneously. Idiopathic cases are further divided into four sub-categories which relate to the age of onset: infantile, juvenile, adolescent and adult.
Scoliosis in its milder forms is not considered life threatening; however when spinal deformity is severe, cardio-pulmonary function can be greatly compromised and can greatly impact the ability to stand “straight”; untreated cases can bend a patient nearly in half.
How is the condition treated?
Treatment for scoliosis usually first involves non-surgical methods depending on the age of the patient and the extent of the curvature. There is no one set treatment course for the condition, each case is complex and so is the remedy.
Non-surgical components of a coordinated treatment plan may include physiotherapy, particularly the Scroth treatment which involves a course of exercises designed to strengthen the muscles of the back and equalize strength deficits. Other treatments include occupational therapy, bracing and body casts, with the latter two being utilized most often in young patients whose bones are still growing.
Scoliosis surgery is usually reserved for patients with a severe spinal curvature and/or those in whom the condition is likely to significantly progress. Patients who have the condition as the result of spina bifida and cerebral palsy are also recommended to have the surgery which improves the ability of the patient to sit and have the care they need; those with breathing problems arising from the condition are also prime candidates; so too are those with curvatures of 50 degrees or more.
Surgery for the condition is called scoliosis spinal fusion surgery. Simply put, spinal fusion involves remodeling the spine into a straighter configuration by realigning the vertebrae and fusing them together (via bone grafting) so that they become one long bone instead of discrete components. The degree of straightening that is possible from the procedure is variable and the vertebrae are only moved within parameters which are safe. Therefore the final outcome may not be a perfectly straight spine, but the curvature that marks the condition is minimized as much as possible.
Types of Scoliosis Surgery
There are two scoliosis surgery types; classified by the surgical angle of approach:
• Anterior: the spine is accessed from an incision in the side of the chest wall.
• Posterior: the incision is made on the back itself and metal instruments are used to effect the correction of the curve. This form of the procedure is also referred to as spinal fusion with instrumentation.
The metal implants used in the posterior type of the surgery replace the old method of spinal fusion which resulted in the patient being immobilized for a period of several weeks to months, while traction and fusion slowly straighten the spine. This version of the procedure also had a high failure rate and even when failure did not occur, quite often the degree of straightening was not significant. Development of the metal implants now used offered an internal bracing of the fusion which allowed patients much greater post-operative mobility during convalescence. There have been many refinements to the metal implants since they were first developed, and their use has expanded beyond scoliosis correction to other types of spinal surgery.
Scoliosis patients who are very young are usually treated surgically via a variation of implant surgery called instrumentation without fusion. Because of the expected years of bone growth still ahead, fusing the spine is not considered desirable. In this variation of the scoliosis surgery, the metal implants are used to straighten the spine and the child must wear a brace postoperatively for a period of weeks or months.
Scoliosis surgery risks
The frequency rate of complications from scoliosis surgery depends on the age of the patient among other factors. In older adults who have a form of the condition called degenerative scoliosis (curvature resulting from the effects of aging) are at a higher risk of wound infections and a condition called pseudoarthrosis which is a form of fusion failure. Rather than staying one long piece of bone, in pseudoarthrosis a so called “false joint” presents at some point along the vertebral fusion. Children and teens rarely develop this kind of failure, but it can occur among this segment of the patient population.
General risks of the surgery for all patients undergoing the procedure include:
• Allergies to medications (anesthesia related complication)
• Breathing problems (anesthesia related most often)
• Bleeding, Blood clots (developing in the legs and travelling to the lungs); heart attack or stroke during surgery, as well as infection (these are the risks associated with any surgical procedure)
• Bleeding that requires transfusion (scoliosis specific complication as are those that follow)
• Inflammation of the pancreas and/or gall bladder
• Injuries to nerves that result in weakness or paralysis—relatively rare
• Lung problems that may not present until a week after surgery and which persist for up to two months
Scoliosis surgery recovery time
Recovery time from scoliosis surgery is variable according to the age of the patient as the time of surgery. In most children and adolescents, a hospital stay of between 4-10 days is common. School age children are generally out of school for at least four to six weeks. Return to normal activities for younger patients can take as few as two months or as long as six months. Older patients and those with complications may take a year or more to fully recover from the surgery.
Scoliosis surgery side effects
Side effects with scoliosis surgery are generally described as long term after effects. According to some research, the complication rate arising from scoliosis surgery is variable and high especially among those with neuromuscular conditions behind the development of the condition.
For those without neuromuscular issues, loss of flexibility of the spine is often cited as a long term after effect of the procedure. While it is often stated that loss of range of motion is minor, the National Institutes of Health report that sideways flexion movement is reduced by anywhere from 20 -60 percent compared to those who have not had the surgery. Spinal fusion also puts strain on the rest of the skeletal structure; stress fractures of the pelvis and other areas have been noted in the literature.
Pain that persists or worsens after the procedure is the leading cause of re-operations being performed.
Infections and inflammatory processes arising from the procedure and not the precipitating condition may arise spontaneously months and even years after surgery.
Curvature of the spine may continue to progress after the surgery. Often this is due to failure of the metal rods implanted in the spinal area. Some patients are unable to stand fully upright; others may lead to the side, in spite of the spinal fusion. Rib deformities may also worsen.
Scoliosis surgery cost
The cost of scoliosis surgery is considerable. Some sources quote an average price of $120,000 US; others quote a range of between $100,000 and $120,000. Because scoliosis is usually considered an orthopedic medical condition, health insurances may cover all or part of the cost; depending on if they accept medical necessity of the procedure.
Scoliosis is considered by some experts to be a largely cosmetic procedure in all but the most severe cases (which affect cardio-pulmonary health); with the end result being a more normalized appearance rather than any lasting overall health benefit.