Scoliosis

Scoliosis is the term given to abnormal lateral curvature of the spine when looked from front or back. If diagnosed early then it could be treated conservatively through bracing and therapeutic maneuvers. For some cases the curve is significant enough which should be operated through screws and rods so as to correct the deformity. Most commonly scoliosis is idiopathic in nature i.e. the exact cause behind it is unknown. It is seen in adolescence commonly hence also termed as “adolescent idiopathic scoliosis” Scoliosis is more common in girls than boys.
Another form of scoliosis is seen in children of young age. This may develop due to incomplete formation or joining of bones and is known as “Congenital scoliosis”. This must be corrected at as early age as possible as the treatment gets more difficult and tough day by day.

What is the procedure for surgery?
• It is major spine surgery. The primary aim of surgery is to correct the deformity. It is most commonly done from behind.
• Infantile scoliosis may be treated with instrumentation without fusion in the form of a growth rod technique. As the age progresses, the rods that are implanted are distracted at an interval of 6 months till the final growth is achieved at puberty. These patients commonly go on to have a permanent fusion with instrumentation as a final treatment modality.
• If the puberty is already achieved then we go for fusion of spine as already the maximum height is achieved.

Is there any alternative to the surgery?
• If the deformity is not severe and not progressive in nature we can try and maintain the curvature through braces or orthotic devices.
• The curvature can be prevented to progress further but cannot be corrected through the orthotic devices.
• But if the deformity is severe and is impinging on the organs then surely surgery is only available option left.

How much time is required for surgery?
It takes around 4-5 hours to perform the surgery depending upon severity of the curve.
Is it necessary to undergo the surgery immediately?
Generally it is advisable to go for the surgery at an early stage if the deformity is severe or the child is going off balance so that maximum correction can be achieved with growing rod technique. If scoliosis correction is done once the puberty is achieved then spinal fusion or arthrodesis is done.
Is there any contraindication for surgery?
If the curve is rigid and fused generally it is not advisable to operate as the complications of paralysis increases. If the co-morbid condition of patient is not optimum then it is advisable not to undergo surgery.

Will the surgery be performed under local or general anesthesia?
This procedure is done under general anesthesia.

What are the Risks and Complications of Scoliosis surgery?
The common complications are-
1 – Chest complication, nausea and vomiting due to the side effect of anesthesia.
2 – Infection may occur as a complication.
3 – Bleeding may occur from the incision site
4 – Wound dehiscence.
5 – Dural tear may occur, leading to CSF leakage.
6 – Bowel/bladder incontinence may occur.
7 – Nerve root damage.
8 – Para-paresis or paraplegia may occur.
9 – Scarring of the skin may occur.

How much time brace is to be wornafter surgery?
The patient has to wear a brace for at least 4-6 weeks. One has to wear the brace as long as 12 weeks sometimes.

Do I need Post operative Rehabilitation or therapy?
Yes you need to under go physical therapy under a trained physical therapist initially for-
• Perform the activities of daily living, for ex. lying to sitting; to stand.
• General conditioning exercises.
• Deep breathing exercises.
• Gentle stretching and strengthening exercises.
• Understand the proper postural stability.

Is scoliosis surgery a risky surgery?
Chance of neurological deficit in Scoliosis surgery is .1%( 1 in 1000). It has been further minimised now a days by the use of neuromonitoring.

How many days I am going to stay in hospital for my scoliosis surgery?
Usually the patient stays for 7 days in hospital. A day before surgery child gets admitted. He will be briefed about the procedure by a surgeon and some preanaesthetic work up will be done. Usually blood is not required for this surgery. It takes around four to five hours for surgeon to complete surgery.

Will I require implants for this surgery?
Implants in the form of screws and rods will be required for deformity correction.

Will my appearance improve after surgery?
Hump over the back should decrease significantly if not disappear after surgery. Shoulder imbalance might become better after surgery. Most of the patients are very happy and satisfied for the cosmetics after scoliosis surgery.

Will I be able to return to sports after surgery?
Yes all most all of the patients are able to return to sports 6 months after surgery. Only gymnastics might have difficulty in returning to sports after surgery.
Will surgery affect my range of motion of spine? Will it affect flexibility of my spine?
The part of the spine which is fused will not have any mobility. But only a part of spine is fused in scoliosis surgery. Rest all the spine will have normal motion. Most of the patients will not be able to notice any change in their range of motion of spine after surgery.