When does one perform surgery for Adult Kyphoscoliosis?

When kyphoscoliosis begins to be painful, conservative treatment may improve the pain and stabilize the condition however it will never correct the actual deformity. When symptoms are not controlled by conservative management more aggressive treatment may be necessary. Surgery for kyphoscoliosis consists of correcting some of the spinal deformity and creating a fusion which means fixing the vertebrae of the spine together by applying instrumentation (metal implants: rods, screws, wires, hooks…) and bone graft. The goal of surgery is to provide the patient with a fused spine which will no longer deform and remain in a position of balanced posture (head centered above pelvis). There are various technique employed to achieve this result and an experienced surgical team is essential.

Can exercises correct a Scoliosis?

One must be aware that scoliosis curves can neither be improved nor their progression prevented by exercises. However exercises for spine stabilization are beneficial for most people with spine problems. After careful evaluation by a spine specialist most patients with scoliosis are encouraged to participate in athletics without reservation (swimming and bicycling are probably better than running).

It is mostly recommended to engage in aerobic exercises with limited amount of resistance (no more than 40 lbs.). Gym exercises can be pursued with upper extremity work outs in sitting and supine positions, using free weights or machines (nautilus or cybex) to indirectly strengthen the supportive musculature of the back. Lower extremities exercises should avoid excessive work in deep knee or hip flexion. Keeping in shape, maintaining normal weight, eating a balanced diet and avoiding smoking are all part of a healthy back regimen.

If your questions are not answered here please feel free to contact us.

When is a Brace used to treat Idiopathic Scoliosis ?

Idiopathic scoliosis is the most common form of scoliosis. This deformity of the spine has no clearly known cause and tends to affect girls more than boys. School screening and regular evaluations by a pediatrician can be helpful in detecting scoliosis at an early age. There are only a few effective treatments which can be recommended. The treatment of a specific curvature will depend upon the severity of the curvature and the age (or skeletal maturity) of a person. In girls, the onset of menarche is a useful guide to the risk of curve progression since it correlates with the decline in growth.

Before puberty a scoliotic deformity may be amenable to treatment with a corrective brace. Bracing may slow the progression of deformity although it will most likely not alter the deformity permanently. Thus a brace in some cases can so to say "hold" the scoliosis so that it does not become severe by the end of growth. After growth has stopped in an adolescent, the likelihood of curve worsening is markedly reduced. As a guideline a curve measuring from 30 to 45 degrees in a growing adolescent may be treated by bracing and close follow-up by a spine specialist. After puberty a curve of 45 degrees or more must be treated by a specialist who may want to watch it for a period of time if the spine is still well balanced, however surgery in the more severe cases is the most common treatment. Bracing modalities and surgery techniques may vary from case to case and should be recommended by an experienced spine specialist after a complete evaluation.

I have Kyphosis due to Osteoporosis, what caused my Spine to collapse?

Osteoporosis is a condition which involves loss of bone mass. All bones of the body are affected in osteoporosis. With the loss of structural strength in the bones the risk for fracture (breaking, or collapse of bone) increases. In severe cases of osteoporosis the vertebra of the spine become so fragile that they may collapse upon themselves even without trauma. Mostly this will cause what is called a compression fracture. These injuries can be very painful and may take several weeks to become less bothersome. Most cases of osteoporotic spine fractures are treated with a brace and pain medication. There are a variety of medications which are used to treat the underlying osteoporosis and decrease the risk of spinal fractures (estrogen therapy, calcitonin, Fosamax…). It is important to obtain proper evaluation by a spine specialist in all cases of spinal fracture.

If your questions are not answered here please feel free to contact us

Does Scoliosis in adults always progress and lead to problems later in life?

Scoliosis in adults is most commonly due to progression of a scoliosis from childhood or a new development related to degeneration of discs, ligaments and joints in the spine with aging. Severe curvatures can lead to pulmonary and cardiac problems over time. Mild curvatures usually do not progress significantly but problems related to degeneration from a scoliosis in adults can lead to symptoms. The most common complaints are back pain, fatigue, tingling or numbness in the legs. In severe cases pain shooting into the legs may develop and weakness may occur.

Surgical treatment for scoliosis in adults is mostly a treatment of last resort. If a curvature is severe, progressive, or leading to neurologic symptoms then surgery may be necessary. For mild curvatures and in the absence of neurologic impairment conservative treatment may be pursued. This would include isometric exercises, physical therapy, possibly bracing, and pain medication.

If I have surgery for Adult Scoliosis, how can I prepare for this?

After a decision to undergo operative treatment has been made, it is essential that you are as healthy as possible at the time of surgery. Continue with the non-operative therapies you have been working on. The professionally guided back strengthening and lung exercises, along with a balanced diet and smoking cessation 2-3 months prior to the day of surgery will give you a better chance of a successful operation. If you are in good physical and nutritional health your risk of complications after surgery is lowered and the recovery phase is shortened.

If your questions are not answered here please feel free to contact us.

If I have surgery for Adult Scoliosis, what will my time in the hospital be like?

In most cases surgery is performed on the same day you are admitted to the hospital. All of the necessary blood tests, X-rays and other testing would be done about a week before the surgery, usually at or near the hospital where the surgery is performed. A thorough pre-operative medical evaluation is included in the pre-admission process.

During surgery you will lose blood. The exact amount depends on how much surgery is needed and the length of the operation. Most of the time the blood you lose is collected and given back to you if necessary. You also have the option of donating your own blood in the weeks before surgery which would be given back if necessary.

After surgery is over you will several tubes. At least one intravenous (IV) line will provide your body with fluid so that you will not become dehydrated. A tube will be placed in your bladder so that the exact amount of urine produced can be measured. A drain may be present in the surgical area, and a chest tube may be present if your surgery involved a chest incision. It is important after operations on the spine to be monitored for changes in strength or feeling in the extremities as well as keeping an eye on all the drains and tubes. For this reason, it is not unusual for patients to spend a day or so in an Intensive Care Unit for observation.

After the operation is over and the anesthesia has worn off, you will begin your rehabilitation. The very first hours you are awake it is important to start deep breathing and coughing exercises to prevent a post operative pneumonia and atelectasis ( when lungs do not inflate properly). It is expected that most patients are out of bed to a chair 24 to 48 hours after surgery. At this point most of the tubes will already have been removed.

A nurse and /or physical therapist will teach you proper techniques to use when getting out of bed and in and out of a chair, and then walking will begin. If necessary a cane or walker can be used for balance. It is important to remember no bending, lifting or twisting is allowed after surgery.

Before you start drinking and eating, your abdomen will be examined and listened to for gurgling noises. If the normal sounds of the bowel are present, your physician will usually permit you to begin drinking. Sometimes nausea and vomiting are present the first day or two after surgery due to the change in position of the spine, anesthesia, pain medication or a combination of all three. Usually medication is given to stop the nausea and vomiting until the problem resolves itself. Occasionally a tube must be placed through the nose into the stomach until the normal function is returned.

The medications most commonly given in adult scoliosis surgery include pain medication to control post-op pain and antibiotics for one or two days to help prevent infection. Pain medication is important. During the first few days after the operation intravenous or intramuscular injections are used to control pain. It is important that you receive enough medication so you can participate in physical activities but not so much that you are sleeping all the time. After the first few days pain medication is changed to tablet or liquid form.

Once you are able to get out of bed and walk around safely, you will probably be ready for discharge from the hospital. This can take about 4 to 7 days and depends upon the type of surgery you had, your age and the speed of recovery from the operation.

If your questions are not answered here please feel free to contact us.

After my surgery for Adult Scoliosis, how long will it take for me to get better?

Gradually over days and weeks, your activity level will increase and the requirement for pain medication will decrease to a point that mild medication will be sufficient. Remember to time the dose of pain medication so that it is most effective when you need it the most like during therapy sessions and at night to provide a good nights sleep.

The surgical wound will usually be dry when you are discharged from the hospital and can be left uncovered after a few days. You should watch for signs of infection such as fever, chills, redness, swelling, or wound drainage. If any of these things develop contact your doctor immediately.

If the wound is healing well, showering can resume at home in a few days. Do not let water beat directly on the wound and DO NOT soak in a bath tub. When drying off gently pat the incision area dry first and then the rest of the body. This will minimize the risks of wound problems.

After discharge from the hospital walking should progress gradually from week to week. It is important to continue to increase activity levels slowly but continuously. The healing progress of your spine will be monitored with x-rays. At your first follow up in the office x-rays will be obtained and these will be repeated about every 6 to 8 weeks after that until complete healing is noted.

In most cases patients can expect to be back to regular activities of daily living and enjoying social activities about 2 months after surgery. Return to vigorous activities may take 6 to 9 months, or until your surgeon has determined that the spine has healed completely.

If your questions are not answered here please feel free to contact us

How do I know if I have Scoliosis?

You may have noted in trying a skirt that one of your hip was jolted forward or in looking in your mirror that one of your shoulders was higher than the other. Your mother may have noted a slight hump in your back. You may have been screened in school by a nurse or a school physician. Your pediatrician may have noted any of the above during his evaluation and told your mother and yourself about scoliosis.

Is there someone I can talk to who has Scoliosis?

Yes and beside people you may know there is a chapter of the Scoliosis Association close to you where you will find someone to talk to. The scoliosis specialist to whom you will be referred may give you a patient to contact.

If your questions are not answered here please feel free to contact us.

Is Scoliosis caused by not drinking enough milk or eating junk food?

No, idiopathic scoliosis which affects usually adolescents is not usually related to malnutrition.

Does Scoliosis hurt?

Usually scoliosis does not hurt, however in some cases of very poor balance, scoliosis may be painful. Pain due to scoliosis can develop if the curve is severe and is also seen in the older age group.

If your questions are not answered here please feel free to contact us.

What are the goals and expectations of Scoliosis surgery?

The goals are: to prevent the deformity from getting worse, to correct some of the deformity, to restore proper balance to the spine and to correct as much as possible the cosmetic appearance of the body. The expectations should be discussed with the surgeon for each specific case according to the type and severity of the scoliosis curvature.

How long will the incision be, and what can I expect in term of scarring?

The length of the incision varies with the amount of vertebrae to include in the fusion, it can go from the top of the back to the waist line or even lower down. In some case a second scar over the pelvis in the back may be left by the incision made for harvesting iliac crest bone graft. If surgical decision was made to treat your scoliosis by anterior surgery you will have an incision following one of your ribs on one side, the length of which may vary from 10 to 15 inches. If the surgery is performed through endoscopy you may have only four small incisions of 1.5 inches each. The scars usually are first bluish and become white and thinner over a year.

If your questions are not answered here please feel free to contact us.

Can you see or feel the hardware under the skin?

Usually the hardware used is low profile and it is not felt under the skin, however in very skinny children it is possible to feel posterior hardware under the skin.

Will I need physical therapy after surgery?

A physical therapist will be available to help you out of bed the first day after surgery and to teach you how to move and walk safely. After the first days following surgery, you will gradually return to normal activities without specific needs for physical therapy.

If your questions are not answered here please feel free to contact us

Will I set off the airport alarm after surgery?

It is unlikely, however very sensitive metal detectors can be triggered by small amounts of metal and they may go off if you are very skinny. It is very unlikely that someone will detect your spinal instrumentation but having a note in your wallet to inform people about your surgery will take this worry away.

Can I have children if I have had Scoliosis surgery?

Yes, and most likely without any problem

If your questions are not answered here please feel free to contact us.