Scoliosis is an abnormal curvature of the spine that affects approximately seven million people in the United States. Scoliosis is a condition where the spine curves abnormally to the right or left side and also involves a twisting or rotation of the bones of the spine. Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis typically affecting 2-3% of children aged 10-18 years old. There are a number of factors that may be related to the risk for AIS progression. These include the patient’s age, pattern of the scoliosis curve present, and gender. Review the condition and non-operative treatment options for AIS.
Curves that are 30° to 35° will likely progress into adulthood and can cause increasing back pain, accelerated disc degeneration, deformity and eventually problems with heart and lung function. Surgery for adolescent idiopathic scoliosis is usually necessary for patients whose curve is larger than 40° to 45 degrees. In these cases, surgery is the best option to prevent further progression of the curvature.
Today, surgical advances allow for greater correction of scoliosis and improved spinal stability after surgery. Most patients begin walking immediately after surgery and resume activities over the following months. Most patients do not require bracing after adolescent scoliosis correction surgery. The decision to undergo scoliosis correction surgery should only be made after a careful evaluation and discussion between the patient, the family, and the surgeon.
For most patients with scoliosis, correction is performed with a posterior spine fusion with instrumentation. Posterior surgery means that the incision is made in the back of the spine. During this procedure spinal implants including rods and screws are attached to the spine and used to correct the spinal curvature. The implants hold the spine in the new position as they fuse or mend. The spine ultimately heals in this new position.
For patients with scoliosis, the spinal specialists at Virginia Spine Institute work to fuse the smallest number of vertebrae possible. This helps maximize remaining motion in the spine. The decision of how many vertebrae to fuse is based on the patient's' x-rays and clinical appearance. This final decision is discussed at length with the patient and their family as part of the surgical decision making. The expert team at Virginia Spine Institute is always committed to performing the least invasive procedures with the least amount of risk for each patient.
A 13 year old girl with progressive double major scoliosis in her thoracic and lumbar spine was followed with x-rays over time and showed that her curves were getting bigger. At the time of surgery, she had a 39° curve in the thoracic spine and a 50° curve in the lumbar spine. Dr. Good performed a posterior spine fusion using pedicle screws. The fixation was strong enough that no brace was needed and she got out of bed the first day after surgery. X-rays were taken two years after surgery and show correction of her scoliosis with excellent spinal alignment. The patient is participating in full activities without pain.
Above are two examples of girls with Adolescent Idiopathic Scoliosis with x-rays before and then after surgery.