Scoliosis
Introduction
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).
Instrumentation
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. Many types of instrumentation
(rods) are now available.
|
John
J. Regan, M.D.