Scoliosis is a condition that affects the curvature of the spine. While a person with a normal spine appears to have a straight spine when viewed from the front or back, a person with scoliosis appears to have a curved spine. In most cases, there is no identifiable cause for the abnormal curvature of the spine, but scientists believe that it is an inherited condition. Other people may have scoliosis due to degenerative changes in the spine, which may be associated with bone collapse from trauma, illness, osteoporosis, or previous back surgeries, while others are born with the condition (congenital).
Approximately two to three percent of Americans have scoliosis by the age of 16 years. Most of these people have mild scoliosis, while very few have spinal curves of greater than 40 degrees that may require surgical treatment. Adolescents who have spinal curves between 25 to 40 degrees may be advised to wear braces to reduce progression of the spinal curve. However, spinal fusion surgery may be necessary for those whose curves are beyond 40 to 50 degrees, especially if the condition causes disabling back pain or trouble breathing.
The goal of surgery is not to straighten the spine perfectly, but to make sure that the curve does not get worse. It involves placement of metallic implants to correct some of the curvature and placement of a bone graft until results it in fusion in the area of the curve.
Spine specialists usually allow patients to return to most of their normal activities after three months, but warn them to avoid rigorous physical activity to allow the spine to heal. They may be able to return to all activities after six to twelve months of evaluation.
Risk, Complications and Long Term Outcomes
Spinal fusion is a major type of surgery that usually takes several hours to accomplish. The success of surgery depends on many factors, such as the degree of flexibility of the curve and the surgical technique used. Furthermore, cases where excellent clinical results occurred (as evidenced from x-rays showing improved spinal curvature) have been reported, but patients were not satisfied due to loss of spinal function or mobility.
Aside from the usual post-operative risks and complications (pain, bleeding, infection, etc) that occur within days of the surgery, there are some risks and complications patients may experience several months or years after their scoliosis surgery. Although long-term risks of scoliosis surgery have yet to be reported, studies show that scoliosis surgery has a high rate of late complications, which include:
- Back pains.
- Failure of spinal fusion, which may cause the rod implant to break.
- Progression of spinal curvature.
- De-compensation or formation of new spinal deformity.
- Increased deformity of the torso.
- Post-surgical degenerative changes in the spine.
- Loss of lumbar curvature (flat-back syndrome), characterized by pain in the upper back and lower neck, difficulty standing up straight, upper back fatigue associated with a prolonged upright posture, and pain in front of the thigh and knee.
- Loss of normal spine mobility.
- Neurological complications (loss of nerve function).
- Lack of patient satisfaction due to functional problems.
Adults who have degenerative scoliosis that is due to aging are more likely to have significant complications compared to children with scoliosis.
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