Scoliosis by Mehmet Aydoğan

Orthopedics and Traumatology

Scoliosis Surgery
by Prof. Mehmet Aydoğan, M.D.

A simple definition of Scoliosis is an abnormal curvature of the spine. It is most often diagnosed in childhood or early adolescence. It is seen about two times more common in girls than boys, but It can also appear at any age.

Prof. Mehmet Aydoğan, M.D.

Orthopedics and Traumatology

Scoliosis causes the spine to curve to one side. Most commonly affected regions are the upper spine and lower back, but the curvature can be in any part. Hereditary is important in Scoliosis & people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severities of the curves from one generation to the next.

Several more specific names or terms for scoliosis are:

Kyphoscoliosis: a combination of outward and lateral spine curvature.
Dextroscoliosis: curvature of the spine to the right.
Rotoscoliosis (rotatory): curvature of the vertebral column turned on its axis.
Levoconvex: curvature of the spine to the left.
Thoracolumbar: curvature related to both the thoracic and lumbar regions of the spine.

Types of Scoliosis

Idiopathic: The cause of scoliosis in most cases is unknown and this is known as idiopathic scoliosis. This type of scoliosis is named based on the age of scoliosis development.

- If the patient is less than 3 years old, it is called infantile idiopathic scoliosis (or early-onset scoliosis). Generally it is related to other problems such as spina bifida, chest wall deformities etc.
- In between 3-10 years of age it is called juvenile idiopathic scoliosis.
- Patients older than 10 years (10-18 years old) have adolescent idiopathic scoliosis.

Functional: In this type of scoliosis, an abnormal curve develops because of a problem somewhere else in the body. This could be caused by carrying heavy loads continuously that cause unequal weight-bearing, one leg being shorter than the other or because of chronic muscle spasms at the back.
Neuromuscular: In this type of scoliosis, there is a problem during the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of congenital scoliosis develops by disorders such as cerebral palsy, Marfan syndrome, muscular dystrophy and other birth defects. It is associated with a long C-shaped curve and weak muscles that are unable to hold patient up straight. If the curve is present at the birth, it is called congenital scoliosis, which is often much severe that needs more aggressive treatment than other forms.
Degenerative: Degenerative scoliosis occurs in older adults. Usually the reason is arthritis (spondylosis). Abnormal curvature of the spine develops due to weakening ligaments and other soft tissues of the spine, osteoporosis or other fractures of vertebra and disc degenerations.

Symptoms and Diagnosis

Signs of scoliosis include:

A visibly curved spine
Leaning to one side
Uneven shoulders
One shoulder or hip sticking out
The ribs sticking out on 1 side
Back pain (This is usually more common in adults)

If you suspect scoliosis, you should consult your general physician. An X-ray of your back will be carried out in hospital to check whether your spine is curved and how severe the curve is.

Treatment

Dealing with scoliosis depends on many factors; namely your age, how severe the curve is and whether it’s likely to get worse with time.

There are three main categories of treatment: Observation, Bracing (for example, thoracolumbosacral orthosis or TLSO back brace), and Surgery. Consequently, there are treatments available that do not involve surgery, but for some individuals, surgery may be their best option.

Babies and toddlers may not need treatment as the curve might improve over time. A plaster cast or plastic brace may be fitted to their back to stop the curve getting worse as they grow.
Older children may wear a back brace to stop the curve getting worse until they stop growing. Sometimes surgery may be needed to control the growth of the spine until an operation to straighten it can be done when they stop growing.
Adults may need treatment to relieve pain, such as painkillers, spinal injections and surgery.

Braces: There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse with good back brace management treatment. Intermittent or chronic discomfort may be a side effect of any treatments used to slow or correct the spinal curvature.

Surgery: If the curve stays below 40 degrees until the person finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person’s life, a long-term effect of the disease. If this is not prevented, the person could eventually be at risk for heart or lung problems.

Non-operative Treatments

Treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery.

Surgery

The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain, restoring a more normal curve and appearance to the spinal column.

Surgery involves correcting the curve back to as close to normal as possible and performing a spinal fusion to hold it in place. This is done with a combination of screws, hooks, and rods that are attached to the bones of the spine to hold them in place. The surgeon places bone graft around the bones to be fused (spinal fusion) to get them to grow together and become solid. This prevents any further curvature in that portion of the spine. In most cases, the screws and rods will remain in the spine and not need to be removed.

There are many different ways for a surgeon to perform the fusion surgery. It may be all performed from a single incision on the back of the spine or combined with another incision along your front or side. In some cases, the surgeon will use a technique called neuro monitoring during surgery. This allows the surgeon to monitor the function of the spinal cord and nerves during surgery. If they are being placed at increased risk of damage, the surgeon is alerted and can adjust the procedure to reduce those risks. Also various different approaches and techniques may be used by the surgeon, based on the location and severity of the curve, but most importantly the experience and knowhow of the physician.

After The Surgery

Surgery recovery and scar formation varies some from person to person. Physician will use medications to control the patient’s pain initially after surgery. A patient will likely be up out of bed to a chair the first day after surgery and will work with a physical therapist who will assist him or her in walking after the surgery. As the patient continues to recover, it is important to improve muscle strength. The physical therapist can help the patient with exercises for the muscles that will also help with the pain. Typically, a young person will miss about six weeks of school and may take about six months to return to their normal activities, although recovery time varies between individuals.

Risks and how to reduce those risks?

As with any surgery, there are risks of surgery for scoliosis. The amount of risk depends partially on the patient’s age, the degree of curve, the cause of the curve, and the amount of correction attempted. There is a minor risk of infection with any surgery. This risk is decreased with the use of antibiotics, but it can still occur in some cases. Other potential risks include injury to nerves or blood vessels, bleeding, continued curve progression after surgery, broken rods or screws, and the need for further surgery.

Possibility of each of these adverse effects is reduced with an experienced surgeon and a well-established hospital facility.

Prof. Mehmet Aydoğan, M.D.

Orthopedics and Traumatology

Medical School, Ege University
Orthopedic Surgery, Kartal Education and Research Hospital
International Fellow of Spine, Comprehensive Spine Center University of California, USA
Worked for Florence Nightingale, Medicalpark, Boğaziçi Spine Center
29 international articles published
Since 2019, Professor, Emsey Hospital

Besides every kind of vertebra surgeries such as vertebra fractures, lumbar narrow canal, herniated disc surgery, laminectomy and minimal invasive surgeries of these, Scoliosis is the major type of surgery that Prof. Aydoğan performs.

Treatment plan changes due to the growing potential of the adolescence, the degree of the curve, the localization of the scoliosis and its pattern. Esthetic appearance and social factors should also be taken into account.

Other than correcting the curve with pedicle screws and rods in each level and maintaining the fusion of the bones, Prof. Aydoğan also uses new methods such as Non-fusion Scoliosis when the patient’s condition is suitable.

In this method, he places screws onto vertebra with endoscopic (thoracoscopic) method without a need for open surgery. These screws are hung to the back of the patient and stretched to correct the curve. The advantage of “Fusion-free” method is that as the patient grows up, correction continues whereas in the conventional method the curve increases by growth and secondary surgeries may be required after few years.