Scoliosis
What is scoliosis?
Scoliosis is a three-dimensional deformity of the spine with predominant lateral inclination. It occurs mainly during a child’s development, shortly before puberty.
Although scoliosis can also be caused by conditions such as cerebral palsy and muscular dystrophy (Neuromuscular scoliosis) or be due to anatomical abnormalities from birth (Congenital scoliosis), most of the time the cause of the disease is unknown (Idiopathic scoliosis). Most cases of scoliosis are mild; however, some children present large deformities of the spine that continue to progress even after their adulthood.
The most common form of scoliosis is idiopathic (80%), and in this form of scoliosis approximately 9 out of 10 children who need some treatment are girls. Severe scoliosis can even lead to disability. A very severe deformity of the spine can reduce the space in the thorax, making the function of the lungs and the heart difficult.
The main symptoms of scoliosis are asymmetry in the shoulders and waist but also the hump on the back (kyphosis). Pain is not a common symptom in young ages, and when it is present, it should be thoroughly investigated. In adults, some forms of scoliosis can significantly worsen and in combination with osteoporosis and arthritis cause pain in the waist and legs and eventually severe disability.
The diagnosis of scoliosis is made with clinical examination and simple X-rays of the entire spine. In some special cases, other imaging examinations may be required, such as magnetic resonance imaging (MRI) or even computed tomography (CT).
The first examination is particularly detailed and can last from 30 minutes up to 1 hour. No special preparation is required, simply the children should know that part of the examination is done wearing only their underwear and that their hair should be tied up high on the head so that it does not fall on their back during the inspection. Re-examinations are usually shorter in duration and are usually combined with imaging re-evaluation (simple X-ray).
Children who present mild scoliosis are systematically monitored with X-rays to check if the deformity worsens. In many cases, no treatment will be needed. Some children will need to wear a brace to stop the progression. The frequency and duration of monitoring depend on the child’s age and the rate of scoliosis progression (if it progresses). It can be every 3 months up to every 2 years. A small number of children with scoliosis may require surgical correction with spinal fusion or spinal realignment
Adult Scoliosis
Adult scoliosis is related to the deformity of the spine from a specific age onwards. Specifically, it concerns rotation and curvature of the thoracic and/or lumbar vertebrae, resulting in the creation of lateral deformity, kyphosis, and the image of the spine resembling a spiral staircase.
Adult scoliosis includes idiopathic scoliosis, which remains untreated since adolescence and worsens throughout life, with the appearance of pain. It also includes degenerative scoliosis, which concerns disc degeneration and wear in general (De Novo scoliosis) as well as scoliosis from spinal fractures (post-traumatic).
Adult & Childhood Scoliosis
What are the differences?
The primary difference with childhood scoliosis is the frequent presence of pain in adults, which is also the reason patients seek medical help. As time passes, scoliosis worsens, and deformities reach a point that hinders the patient’s daily life. The disc degenerates and patients may present neurological symptoms due to nerve compression. At this point, surgical treatment of scoliosis provides a solution.
What are the causes of adult scoliosis?
Adult scoliosis is usually idiopathic, meaning without a specific identifiable cause, and has developed since adolescence. In cases of De Novo scoliosis (scoliosis that was not present before adulthood), the etiology lies in asymmetric wear of the supportive anatomical elements of the spine, which occurs progressively.
What are the consequences of scoliosis?
- Depending on the curvature, height loss of up to 10 centimeters occurs
- Pain and intense loading of the posterior spinal joints (Facet joints)
- Asymmetric loading and degeneration of the intervertebral discs
- Spinal stenosis and neurological complications
All of the above, combined with ligament laxity and muscle atony, lead to failure of the entire spine.
What are the symptoms of scoliosis?
Scoliosis is characterized by spine stiffness, which is more intense depending on the degree of spine degeneration. As age progresses, symptoms of pain, numbness, cramps become more intense, mainly due to disc and joint degeneration and nerve element compression.
All the above, if coexisting, naturally limit the patient’s daily life greatly and degrade quality of life. The condition worsens if there is increased body weight.
The rate of scoliosis progression is slow and steady, with an increase in the scoliosis angle of 0.5-1 degree per year on average. Location of scoliosis plays an important role. It has been shown that lumbar scoliosis worsens faster and to a greater degree than thoracic scoliosis. Any deformity may accelerate rapidly when osteoporosis coexists and worsen with osteoporotic fractures.
How is scoliosis diagnosed?
Given that scoliosis causes visible changes to the body, there are some signs that can lead to its diagnosis from simple clinical examination. These are:
- One shoulder is higher than the other
- The ribs are more forward on one side than the corresponding on the other side
- One hip is higher than the other
- The waist is asymmetrical
- There is a hump (kyphosis) on the back or waist
The forward bend test (Adam’s test) is the most common test for the appearance of total spinal deformity. The patient bends forward with hands towards the feet, knees straight. In the presence of scoliosis, one side of the torso protrudes more than the other (hump).
Scoliosis
Treatment – Management
Treatment of adult scoliosis has many parameters to be considered by the orthopedist. Age, size of the curvature, degree of body asymmetry, and frequency of symptoms are factors taken into account to decide the appropriate (conservative or surgical) treatment.
The brace, which functions therapeutically in children, has limited indications in adult scoliosis as bone growth is complete. Essentially, it is used only adjunctively in patients who cannot be otherwise treated for pain relief.
Small and large scolioses: What are the treatment methods?
In small adult scoliosis of middle age with the main symptom of low back pain (without nerve compression), treatment is successful and limited to medication, physiotherapy, and injections of special solutions into the lower back for symptom relief by a specialized scoliosis orthopedist. The accompaniment of an exercise program aiming at muscle strengthening will also reduce the frequency and intensity of pain and minimize relapses.
In large adult scoliosis, over 50 degrees, where relapses dominate and frequent symptom worsening occurs, surgical treatment is imperative. This is performed with modern safe methods and has excellent results when carried out by an experienced specialized spinal surgeon. Also, another reason that may be considered for surgical treatment is the aesthetic improvement of the spinal appearance and prevention of its worsening. The method considered the most modern solution for large and rigid curvatures is minimally invasive lateral spinal fusion followed by posterior spinal fusion.
Minimally invasive lateral spinal fusion
The primary goal of spinal fusion is the correction of the curvature and its re-establishment with special materials in the optimal position. This is achieved by placing cages that are wedged into the position of degenerated discs. Simultaneously, bone graft is used.
The surgery is performed with minimally invasive lateral approach (MIS).
Scoliosis
Frequently Asked Questions
What is the role of the orthopedist when an adult scoliosis patient visits?
The specialized spinal surgeon and director of the scoliosis department of the Athens Medical Center, Dr. Starantzis, offers a comprehensive evaluation and treatment plan of scoliosis depending on its severity and the age of the patient.
The doctor will thoroughly explain what you should do for your case and will inform you fully about the benefits and risks of each treatment method. If you wish, he will proceed with surgical correction of your scoliosis.
What is the cost of scoliosis surgery?
The cost of scoliosis surgery depends on many factors. Some of these are the length of hospitalization, the type of materials used, the quality of the graft material. Also, the cost varies from country to country. In Greece, it is at affordable and stable levels. These surgeries are fully covered by most private insurances, while part of the hospitalization can also be covered by EOPYY. For more details and an exact cost estimate based on the surgery you need, please contact us.
What will happen if scoliosis surgery is not done for deformity over 50°?
If severe scoliosis is not treated surgically, it can lead to extensive arthritis (wear) with intense/debilitating pain but also to spinal stenosis with neurological symptoms and complications. It can also cause pain from muscle fatigue and eventually devastate the patient’s psychology due to the deformed appearance and unbearable pain.
What does robotics offer in scoliosis surgery?
When spinal fusion is necessary, the orthopedist can choose to perform the surgery with cutting-edge technology offered by the field of robotics. Innovative digital tools increase the safety and accuracy of the placement of surgical materials – grafts and may prove in the future to improve clinical outcomes.
Robotic scoliosis surgery possibly reduces complication chances due to exceptional accuracy. The desired implant position is already designed before surgery, using a computer, and so during surgery the doctor guides the robotic arm to the specific position. A disadvantage of the method is its higher cost.
