Scoliosis

Description

Treatment for Adult Scoliosis

Adults who had been surgically treated for scoliosis in their youth are at risk for disk degeneration and spinal fusion failure. In most adults with previous scoliosis, moderate exercise is not harmful and is extremely important for maintaining healthy supportive muscles and preventing disk degeneration. In one study, Pilates, an exercise practice that uses yoga principles, was helpful in a woman with progressively and disabling severe low back pain and who had a history of fusion surgery. This approach deserves further research. The only cautionary note is for people with only one or two mobile lumbar vertebrae below the area that was fused during surgery. These people should avoid activity or exercise that causes excessive twisting on the spine; some experts believe this may accelerate spinal degeneration.

Nonsurgical Treatment of Adult Scoliosis

In most cases of adult scoliosis, nonsurgical care is preferred if possible. This can include patient education, exercises, and medical treatments. Braces are not useful.

One center reported that epidural steroid injections were a beneficial alternative to surgery in patients with degenerative lumbar scoliosis.

In one case study, a middle aged patient with severe scoliosis experienced significant chest expansion and fewer respiratory infections using an approach called comprehensive manipulative medicine (CMM) along with daily traction and massage. Professionals who employ CMM first analyze a person's posture and movements and apply specific techniques to the most disabled parts of the body. This warrants more research.

Surgical Treatment in Adult Scoliosis

Candidates for Surgery. In general, pain is the most common reason for surgery in adult scoliosis. Surgery may be recommended in the following cases:

• Curvatures over 50 degrees with persistent pain.
• Surgery is almost always recommended for adults with curvatures over 60 degrees; those over 100 are life-threatening.
• Progressive mid and low back curve or low-back curve with persistent pain.
• Reduced heart and lung function. Most surgeons, however, will not operate on adults with severely impaired lung function and heart failure. Once this has occurred, most experts do not believe that surgery will help lung capacity and in fact, surgery can cause the condition to worsen, at least temporarily.
• Significant deformity is present. Adults should not expect to achieve a completely straight spine, however. There is a high risk for nerve damage if the spine is over-corrected, and adult spines are less flexible than childrens are. Usually, however, the correction still achieves an acceptable cosmetic improvement.

Surgeons prefer to operate on adults under 50 years old, although surgery may be appropriate in some older people.

Standard Scoliosis Procedures in Adult Scoliosis. The procedures involve the following depending on whether the patient had been treated previously or not.

• In patients who have not had previous treatment and who have degenerative lumbar scoliosis, the procedure is often a discectomy (removal of the diseased discs) followed by scoliosis procedures (instrumentation and fusion).
• In patients with previously treated scoliosis, the only remedy is removal of the old instrumentation, extension of the fusion, and implementation of new instrumentation and bone grafts.

Surgical procedures in adult scoliosis are complex and are undertaken only after careful consideration and all nonsurgical methods have been used. Adults have a much higher risk than children for complications, including pneumonia, infections, poor wound healing, and persistent pain. In addition, procedures in adults often involve fusion in lumbar and sacral areas (the low back), which can cause a number of complications. Some experts believe that the risks of operations in this area nearly always outweigh any benefits in adults and should not be performed. Most studies on adults have also reported low success rate.

Others argue that without an operation, the back will become unstable and painful. In addition, most studies on adults report on procedures using the old Harrington instrumentation techniques. Advances in instrumentation are increasing success rates in adults.

In fact, in a 2002 study, for example, excellent results were obtained in adults who underwent anterior fusion and instrumentation. In a 2003 study of newer generation instrumentation, 87% of adult patients reported satisfaction. Unfortunately, few studies have been conducted on the best approach to this problem, which is increasing in numbers as women who had been surgically treated in childhood get older.

Wedge Osteotomy. In patients with mature spines, wedge osteotomy is being investigated as corrective surgery and as an alternative to braces. In this procedure, wedges of bone from the concave side of the curve. They then straighten the spine by closing the cut section. The patient needs to have a temporary rod in place and to wear a brace and restrict activity for about 12 weeks or until the bone has healed. The rod is removed and the spine is mobile. The safety and effectiveness of this procedure is being studied.