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.
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