Has Scoliosis Surgery Been Recommended For Your Child?
Scoliosis surgery can be daunting. If your child has scoliosis, understanding the options and surgical procedure will help to relieve anxiety about what is to come. Is surgery always necessary to control this lower back pain condition? Learn about what to expect before, during, and after surgery to help your child obtain the best outcome possible.
What is Scoliosis?
Scoliosis is simply an abnormal curvature of the spine. In the spine, there are some curves that are normal and some that are not. In the cervical and lumbar regions, lordosis or an inward curve is normal. In the thoracic spine, kyphosis or an outward curve is normal. These curves in the spine occur from front to back. Scoliosis involves a twisting or rotational curvature of the spine resulting in a curve that appears as a “C” or “S”.
Scoliosis occurs twice as often in girls as in boys and begins between the ages of 8 and 10. The most common form is idiopathic scoliosis which simply means scoliosis that develops without a specific cause. There is a genetic component to scoliosis as it does run in families.
Signs and Symptoms of Scoliosis
The most common sign of scoliosis is the visible curvature of the spine. Often the shoulder or hips will look uneven. Routine school screening and routine pediatric doctor visits are generally when curvatures are first detected. If the curve progresses, symptoms including back pain, headaches, and shortness of breath may be felt.
Scoliosis is diagnosed by both physical exam and x-rays. Visual assessment of the spine is done as the patient bends to touch their toes. A twisting of the spine or rotation of the ribs is visualized.
X-rays are used to confirm the diagnosis and determine the extent of the spine curvature. Measurement of the curve of the spine is called the Cobb angle. The degree of curvature will determine the recommended treatment.
The good news is that most spine curves are mild and do not require treatment. If the angle is 15 degrees or less your child will be re-evaluated every 4 to 6 months to monitor the progression of the curve.
Specifically when children are growing, the curvature can progress. The first line of treatment is generally bracing. Bracing is generally recommended when the curvature has progressed beyond 20 degrees. There are a variety of braces utilized based on the type of curvature including the Milwaukee, Boston, and TLOS brace. The purpose of the brace is to keep the curvature from getting worse as the child grows. Bracing can be traumatic for the child as most of the braces should be worn 20 hours or more a day.
The good news is that bracing is generally effective if the patient is compliant with wearing it as directed. Physical therapy can also helpful minimize the tightening of the muscles and soft tissue around the curvature.
If the spine curvature progresses to greater than 40 or 50 degrees, scoliosis surgery is generally recommended. Variables that effect the timing of the surgery may include the location of the curve, the number of curves, how quickly the curve is progressing, and if child is still growing.
The primary purpose of the surgery is to prevent progression of the curve. Although attempts may be made to correct the deformity that has already occurred, it is more realistic to expect curvature reduction than restoring of normal alignment.
Surgery involves an incision in the posterior aspect of the spine. The child lies on their stomach as the procedure is performed. The length of the incision will be based on the location and extent of the curvature. The muscles of the spine are moved in order for the surgeon to access the spinal column.
Surgery for scoliosis is a form of
Rods and screws are connected to the individual vertebrae and a wire is often used to help realign and straighten the curve. The use of Harrington rods are a common fixation device for this type of fusion.
In many cases, a bone graft is used to connect one vertebra to another to form one segment and provide additional strength to keep the bones in place. Although donor bone material may be used, the surgeon may harvest bone to be used for this bone graft from the child’s pelvis (called an autograft). Generally bone that comes from a synthetic form or donor is not as successful as the autograft.
Scoliosis surgery is involved and generally takes 4 to 6 hours to perform, depending on the specific case. Recovery in the hospital will generally be between 3 to 5 days. Pain control following surgery is an important aspect to recovery. Increased pain will result in decreased tolerance for movement and deep breathing, both of which are important to regaining function. In the hospital a physical therapist will help with initial movements including moving out of bed, walking and stair climbing in preparation for the return home. In many cases, the use of a post-operative brace will be required with the length of time being dependent on both the procedure performed and healing rate.
Complications following surgery for scoliosis are varied and can include spinal pain, bleeding, infection, neurological damage, stress on adjacent vertebrae that are not fused, failure of instrumentation, and continued curvature progression. Following your doctor’s post operative recommendations and being consistent with follow up appointments will help assist your doctor in monitoring the healing process.
Following scoliosis surgery, activity will generally be limited. Normal every day activity can occur but exercise is generally limited for the first 6 months. After x-rays indicate healing is progressing, activities such as swimming and biking may be added. Sports type activities can generally be resumed after one year. Fusion will generally take 3 months with complete healing up to 2 years.
• Scoliosis is an abnormal curvature of the spine and is diagnosed via visualization of the curve as well as x-rays measuring the Cobb angle.
• An angle of 15 degrees or less is generally monitored with no specific treatment recommended.
• For spinal angles greater than 20 degrees, bracing is the treatment of choice.
• If the angle of curvature has progressed beyond 40 degrees, scoliosis surgery is generally recommended.
• Surgery involves the placement of screws, rods, wires, and bone grafts to help fuse and minimize the spine curvature.
• Complications can be varied requiring thorough communication and follow up with the surgeon.
• Activity is generally limited for the first six months with complete healing taking up to 2 years.
Facing scoliosis surgery can be daunting. Communicate with your physicians in order to understand your child’s condition and options and ensure the best outcome as possible for your child.