Mr Ben Okafor FRCS (Orth.)

Consultant Orthopaedic and Spinal Surgeon

Scoliosis of the spine

A normal, healthy spine curves both to the back and front of the body. Each curve provides unique support to the back, allowing back muscles to work efficiently and nerves to function unimpeded. From the back view, however, the normal spine is straight, providing a balanced and stable structure for the body.

What is scoliosis?

Scoliosis results from an abnormal curvature of the spine when seen from the back.

When the curvature is more than 10 degrees, scoliosis is present. This side-to-side curvature might only be seen on x-ray, but may also be obvious simply by looking at or feeling the back. This curvature develops slowly and may not have any symptoms at first.

Adult scoliosis generally is one of two types: those with beginning stages of scoliosis during childhood and those who develop abnormal curvature with age. Symptoms are generally in the lower area of the spine and are due to degeneration (wear and tear) of the supporting structures, such as the intervertebral discs – the 'cushions' between the vertebrae. Spinal curvature, along with arthritic changes, put pressure on the nerves by reducing the space available for the nerves. Besides back pain and stooped posture, problems with the legs may occur such as numbness, pain, weakness, heaviness, and tingling which limit activity and make walking difficult.

What causes scoliosis?

Primary (idiopathic) scoliosis occurs most frequently in young females, but may occur in any child. Idiopathic means it's cause is unknown, but usually develops during the growth years, ages 12-16. Secondary scoliosis may result from the spine compensating for a nonstructural spine problem such as muscle spasms, inflammatory conditions, poor posture, injury, disease or difference in leg lengths. It may also be caused birth defects, tumors or other diseases such as muscular dystrophy or cerebral palsy.

Can scoliosis be prevented?

Good spinal care includes good nutrition, especially during the growth years, but continuing as an adult. Calcium intake needs to be maintained throughout adulthood. Sensible exercise programs that maintain the strength of leg and back muscles helps reduce injury and deformity. Good posture is vitally important to maintain the supporting structures. Early treatment and intervention of beginning scoliosis through the use of physical therapy, chiropractic and exercise can reduce the degree of curvature.

What treatment options are there for scoliosis?

Depending on the cause of the scoliosis, a variety of treatment options are now available.

Endoscopic thoracic release

An endoscope is a small instrument which permits peering into the body through a small opening, minimizing the size of skin and muscle incisions. Endoscopic thoracic release involves the removal of discs, the separation of ligaments, and in some cases the removal of a portion of several ribs to facilitate correction of a deformed spinal column.

The thoracoscopic release technique involves general anesthesia with the patient lying on the side. The endoscope and other specialized instruments are introduced through skin incisions approximately 1 inch long in the side of the chest. The lung in the surgical area is deflated. A camera attachment on the endoscope allows the doctor to see the chest cavity and spinal column on a TV monitor.

The discs, ligaments and rib segments are resected to gain motion across the deformed spine. Once this has been achieved, the lung is reinflated, the small skin incisions are closed and the procedure is completed.

Endoscopic correction of scoliosis

Traditional open spine surgery for scoliosis leaves a large scar. Endoscopes, fiberoptic video cameras, and other specially designed surgical tools have made it possible for surgery to be performed through small holes instead of large incisions. Endoscopic surgery has potentially less blood loss and scarring, reduced disruption to the rib cage and other surrounding areas, less post-operative pain, and faster rehabilitation and recovery.

Endoscopic correction is not possible with all types of scoliosis, but single right thoracic curve is ideal for this method.

Spinal fusion

Fusion is a surgically created solid bone bridge between two or more adjacent (usually freely mobile) bones. In the spine, this procedure is used to create a stability between vertebrae. In order to achieve a fusion, bone must grow across the desired area in a gradual and solid fashion. A number of techniques can increase the chance of this to occur. The basis principle is to place bone tissue (bone graft) into the area of desired fusion, ensure sufficient immobility across that area (brace, cast, spinal instrumentation) and then wait for the fusion to take place (6-9 months or more).

To straighten the spine in scoliosis patients, the doctor attaches hooks to the vertebral bodies. Then two titanium rods are inserted to either side of the spine. A piece of bone from the patient's hip (a bone graft) is applied to portions of the spine to assist fusion by growing into the spaces between the vertebrae and acting like a cement to hold them straight. This is called a "spinal fusion." Until these bones heal together, they need to be supported and kept from curving again. The rods accomplish this purpose by holding the spine straight until the bones are fused together. 

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