What is scoliosis?
A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows a side-to-side curvature, with the spine looking like an "S" or "C." The back bones (vertebrae) may also be rotated. This makes it look like the person is leaning to one side. Scoliosis is defined as a curvature of the spine measuring 10° or greater.
Scoliosis is not due to poor posture.
Spinal curvature from scoliosis may occur on the right, left or both sides of the spine. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis.
What causes scoliosis?
The cause of scoliosis is unknown in most cases, but it can develop as a result of breakdown of the spinal discs, as seen with arthritis, osteoporosis, or as a hereditary condition that runs in families.
Early detection of scoliosis is most important for successful treatment.
How is scoliosis treated?
The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:
Observation and repeated exams. This may be needed to determine if the spine is continuing to curve, and are used when a person has a curve less than 25° and is still growing.
Bracing. Bracing may be used when the curve measures more than 25° to 30° on an X-ray, but skeletal growth remains. It may also be needed if a person is growing and has a curve between 20° and 29° that isn't improving. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.
Surgery. Surgery may be recommended when the curve measures 45° or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing.
Surgery to correct scoliosis
Scoliosis surgery is designed to improve a severe spinal curve and to keep it from getting worse by permanently joining the bones (vertebrae) together. The goal is not to completely straighten the spine, which may cause damage to the spinal cord. Instead, the goal is to restore the spine to a more normal alignment and appearance, and also to address any back pain or heart or lung function problems caused by the scoliosis.
The highly skilled orthopedic surgeons at the Cooper Bone and Joint Institute are at the forefront in performing scoliosis surgeries.
Understanding the procedure
For scoliosis, spinal fusion is the most common surgical procedure. During this type of procedure, an incision (cut) is made down the middle of the back. The surgeon very carefully moves the spine into a more normal alignment and attaches a metal rod to each side using hooks or screws attached to the bones. The rods act like an “inside brace” as they hold the spine in the straightened position. Then the surgeon puts in a bone graft, usually using bone from a person’s own body (autograft), a biological substance (which will stimulate bone growth), or from a donor (allograft) to help the bones in the spine fuse together over time and hold them together and straight.
This procedure can be performed through the back of the spine (posterior), from the front (anterior), or in a combination front and back approach (anterior-posterior).
The surgeon will decide which surgical approach (posterior, anterior, anterior-posterior, or minimally invasive) is best based on several factors, including the severity of the curve, its location, and its cause.
Indications for the procedure
Surgery is an option used primarily for severe scoliosis (curves greater than 45 degrees), for curves that do not respond to bracing, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing.