Scoliosis is a condition where the spine is curved from side to side. In most cases, there is no clear cause of deformity - this is referred to as idiopathic scoliosis. A smaller number of patients may be found to have congenital (a condition present from birth) or scoliosis may be caused by other neuromuscular disease.
It is important that scoliosis is assessed and treated from an early age. As a patient gets older, the likelihood of a successful correction becomes less over time as the growing process slows down.
Early symptoms of scoliosis can include unual prominence of ribs or shoulder blades, uneven hips or leg length or uneven muscle tone on one side of the spine.
Any patient suspected of having scoliosis will be examined by a consultant spinal surgeon to assess whether there is any known underlysing cause for the deformity. The examination will normally include
- Checking the skin for 'café au lait' spots, which can suggest neuromuscular disease
- Check the feet and gait of a patient for foot deformity
- Muscle tone of the back and abdomen
- A physical exam known as 'Adams Forward Bend Test' can be carried out to check the back in the forward curved position for any visible asymmetry of the spinal column
When scoliosis is suspected it is normally appropriate to arrange for x-rays to be taken of the patient's back. The different views that will be taken include a front to back and also a side to side x-ray. The front to back x-ray will show any left to right curvature, while the side to side view will show any kyphosis (forward curvature of the spine) or lordosis (backward curvature of the spine). Standing x-ray is the normal way to track the severity and progression of scoliosis over time (the interval is anywhere from 3 to 12 months in growing individuals).
In some cases, MRI investigation is necessary to evaluate any impact on the spinal cord itself.
Scoliosis is a progressive condition and it will worsen if left untreated. It is not always necessary to undergo surgery, depending on the age at which the condition is diagnoses, severity of the curve and how quickly it is progressing.
The most well tested methods for managing a patient with scoliosis are:
- Observation - in some cases where there is a slight curve it is appropriate to monitor the patient's back and if no progression is found further treatment will not be necessary.
- Physiotherapy - where there is a small curve physiotherapy can be an effective method or slowing the curvature and possibly halting its progression. Physiotherapy is also an important adjunct to other treatment methods available.
- Bracing - braces are used in patients who are still growing, in order to halt the progression of the curvature and avoid needing surgery at a later stage. The brace is like a corset and there are a variety of options available, the specific brace used will be individually tailored to a patient.
- Surgery - an operation can be carried out to straighten and hold a patient's spine in a more normal position, although this usually results in reduced flexibility of a patient's back.
Surgical correction of a scoliosis deformity is by spinal fusion, using specialised instrumentation.
Modern systems for correcting spinal deformity try to address the problem by using a combination of hooks, screws, rods and wires fixing the spine by applying strong forces to the spine. These forces will be calculated to oppose the force or direction of movement responsible for the curvature.
In general, spinal fusions have good outcomes, with high degrees of correction and relatively low rates of failure and infection. Patients with fused spines and permanent implants in their back tend to lead normal lives with relatively unrestricted activities.
Whether the treatment for scoliosis is non-surgical or surgical, it is important that the patient is monitored regularly for any changes.
Braces and physiotherapy programmes can be adjusted over time according to how the non-surgical management of scoliosis progressing.
If surgery is carried out, after the operation is complete patients will be moved to the recovery ward until the nurses and anaesthetist determine the patient is stable enough to return to the ward. In some cases, especially where there has been a severe curve, patients may need to stay in the hospitals critical care unit (also known as an ITU) for one or two nights. Once ready to move to the ward, patients will spend between three and ten nights on average. It is also not uncommon for patients to notice unexpected pain or symptoms and but this is caused by temporary localised swelling from the operation itself, and can be managed with pain relief medication.
Rehabilitation and prevention
It is important to follow the exercises set out by the physiotherapists or consultant spinal surgeon on an ongoing basis in order to maximise recovery after surgery and reduce the risk of stiffness and loss of mobility as much as possible. It is also important that patients are familiar with the do's and don'ts as to avoid overdoing themselves. Exercise programmes are best tailored to individual patient's needs.
Recovery after surgical intervention will take time, as it is a major operation. Following the guidance from the consultant spinal surgeon and physiotherapists is an important part of reducing the recovery time.
For any enquiries please contact Mrs Mandy O'Sullivan who will endeavour to help you in any way possible.