Spinal Curvature (Scoliosis)
Types of Scoliosis
The most prevalent (80%) is the so-called idiopathic scoliosis. Its cause is unknown. Generally manifests itself during the growth spurt years, ages 7-9 or 12-15. The side to side curvature of the spine is accompanied by the rotation of the vertebrae around the axis leading to the development of a hump at the dorsal spine segment and an anterior protrusion alongside the lumbar spine. Rarer is the congenital scoliosis caused by improper development of the vertebra and the vertebral arch.
Others: curvature may develop as a consequence of conditions such as neurofibromatosis and Scheuermann's disease that cause the vertebrae to loose their firmness. Loss of muscle strength may also lead to deformities since muscles not doing their job in supporting the spine, will cause the curvature.
In all types of scoliosis, it is true that, unless the deterioration of the curvature stops, severe deformity will result, decreasing the respiratory surface of the lung, making blood circulation in the lungs more difficult and, thereby, causing the work of the heart to be much more difficult. Damage to the lung is followed then by cardiac insufficiency. The Patient eventually becomes unable to bear any weight and loses the capacity to work. In addition, the degenerations of the spine causing the pain speed up and severe cosmetic changes develop.
Foremost in spinal deformities is early detection. In very mild cases, no therapy may even be necessary. In more pronounced cases, conservative treatment (physiotherapy, corset) may be required. If conservative treatment was not possible due to the advanced maturity of the bone structure, or, did not prevent further progression and it became evident that the Patient's condition
Indications for Surgery
• reaches, or exceeds 50 degrees
• the 40-50 degree curvature shows definite progression
• reaches, or exceeds 45 degrees
• the 35-45 degree curvature shows definite progression
• the intense pain resulting from the deformity was not alleviated in spite of conservative treatment
• curvature is greater than 50 degrees and continual progression confirmed
1.One-step interventions - in cases of milder deformities, supple curvatures
Anterior approach corrective surger
The spinal vertebrae are reached through an incision made in the front of the body between the ribs and alongside the abdominal wall. The discs are then removed from the segments involved and the vertebrae bound together by means of screws and rods, thus completing the correction. The discs that were removed are then replaced by autologous bone harvested either from the rib sections that were removed during the procedure or the spongy bone part of the iliac bone. Prior to closing the wound, a small tube is inserted into the chest cavity for the removal of excess fluids draining from the wound for 3-6 days.
Posterior approach corrective surgery
A longitudinal skin incision is made along the midline on the posterior surface of the dorsal or lumbar segment as determined by the deformity. The muscles attached to the spine are carefully removed and the screws and rods put in place to correct the curvature. The surface bone layer on the posterior side of the vertebrae in the fixed segment is removed and replaced by spongy bone obtained from the iliac bone, thus, enabling ossification to occur. Prior to closing the wound, a small tube is inserted under the musculature for the removal of excess fluids draining from the wound for 2-3 days.
2. Combined approach corrective surgery - in cases of more severe, less supple curvatures
The first phase follows the anterior approach incision procedure described above. The intervertebral discs causing the rigidity of the curvature are then removed, a drain placed in the chest cavity and the wound closed.
The second phase is done by the posterior approach procedure correcting the deformity as described above. The two surgeries may be done consecutively, on the same day, or on different days. In more severe cases, when the Patient's bearing capacity is low, the second correctional surgery may be performed 2-7 days following the anterior approach
The combined approach technique (used in cases of severe rigid curvatures of 100 degrees or more).
In preparation for the surgery, the patient must first be placed under traction as follows: following the administration of either general or local anesthesia, a metal ring is fastened to the patient's skull with screws. This is then attached to a pulley system allowing for the gradual increase in weights and pull on the entire body. The device must be worn 24 hours per day, every day, for 3-4 weeks, depending on the results. The patient may lie down or sit and, with the help of a specialized frame, stand, walk, use the bathroom, take a shower and shampoo his or her hair.
Following the 3-4 week traction treatment, the Patient undergoes the releasing surgery described above. This is followed by another 3-4 weeks of traction whereupon the already described posterior approach corrective surgery is performed.