Adolescent idiopathic scoliosis usually appears during the late childhood years or adolescence. In this an abnormal curve is observed in the spine. Instead of being straight as in normal individuals, the spine has a sideway curve, which is in an elongated "S" or "C" shape with the bones twisted slightly.
In most cases the spinal curve is stable, although in some the curve progresses and severs over time. For some unknown reasons, the progressive curves are more frequently found in girls. However, mild curve is common in both girls and boys.
Generally, in adolescent idiopathic scoliosis there is no pain or any neurologic symptoms. The spinal curve does not pressurize the organs like the lungs or heart, and indications such as shortness of breath are not felt. When scoliosis begins at a young age, patients may feel some back pain, mainly in the lower back area. Associated with scoliosis, it is seen that the curvature does not result in pain. Many youngsters experience pain due to getting engaged in a lot of physical activities. However, if pain persists, further evaluation and testing may be necessary.
- Postural Screening Exam- At the docltor’s clinic, scoliosis is diagnosed by looking at the adolescent’s posture from a 360 degree angle. The doctor ensures that the neck, head and pelvis are at a midline and verify the symmetry of shoulders, scapula, legs, palms and hips.
- Spine Exam- After an extensive patient’s record, the patient might be examined further using the following techniques:
- Adams forward bend test with an inclinometer, which helps the doctor to understand the torso asymmetry
- Assessment of the ligament laxity for connective tissues
- Neurological examination
- Standing X-Ray
- MRI Study
Treatment of Adolecent Idiopathic Scoliosis comprises of either operative or non-operative procedure.
Non-Operative Scoliosis Treatment
Although the majority of patients do not require any surgical treatment, yet they are observed over time or braced. Curves between 20 to 40 degrees in skeletally mature patients do not require any surgical treatment or bracing. If the curvatures are between 25-40 degrees bracing is suggested. Patients are monitored closely and evaluated at every 3-6 month intervals. Evaluations are less frequent once growth has ceased.
Observation is used on patients whose curves are less than 25 to 30 degrees but are still growing —or for curves less than 45 degrees in patients who have developed the scoliosis. Scoliosis surgeons frequently study the scoliosis over time to make sure it does not progress into maturity. AIS patients with curves more than 50 degrees are in all likelihood to increase into maturity at a range of 0.5 degree to 2 degrees in line with a year.
The job of a scoliosis brace is to halt or slow downthe progression of the curve – with a purpose of avoiding a spinal surgical treatment (and the recovery and side effects that come along with it). Over the years the designs of scoliosis braces has evolved, ensuing in more effectiveness. There are numerous types of braces that are available. The most important attribute of bracing is that it must be well-fitted and that the patient needs to adhere to the bracing instructions.
Surgical treatment is often recommendedto patients whose curves are more than 45 degrees and have stopped. Surgical treatment nowadays uses steel implants which can be connected to the spine, and then connected to single or double rods. Implants are used to correct the backbone and preserve the spine in the correct position until the instrumented segments fuse together in the bone. The purpose of surgical treatment is to:
- Prevent curve development
- Obtain some curve correction
The surgical operation can be completed with either a posterior or anterior method:
- Posterior approach: A straight incision is made along the midline of the back. This approach is used most usually within the treatment of AIS and may be effective for treating all kinds of curves.
- Anterior technique: A comparable incision is made through the front of the spine. This method is an alternative method in instances where thoracic curve or a lumbar curve is to be treated.
Before The Procedure
The surgery is done under general anesthesia, so the anesthesiologist evaluates the patient in detail and prepares for administering anesthesia.
During The Procedure
- Scoliosis surgery may be done by anterior or posterior approach, but in both cases, there is use of screws and hooks that are attached to the bones. These are used to anchor long rods that help to reposition the spine and align it correctly.
- Once the rods are held in position with the hooks and screws and the spine is properly aligned, bone grafts are introduced for spinal fusion. These grafts may be taken from the patient or from a donor.
- The bones are allowed to fuse which may take 3-6 months or an year. The rods are not removed since that involves another surgery. However, in some cases, they may cause irritation to the soft tissues in their vicinity which may call for their removal.
After The Procedure
- The hospital stay lasts for nearly 3-7 days.
- An epidural catheter may be inserted to relieve back pain of the patient. This is removed most likely on the third day.
- A catheter may be also connected for urination. This may also be removed on the third day.
- The patient is kept under supervision of doctors. A physiotherapist helps the patient to recover and carry out normal routines.
- An X-ray is taken before discharge and follow up instructions are given that ensure the well being of the patient.
- The movements of the patient have to be restricted for the first six months and only necessary simple routine must be followed.
- Regular X-rays and follow up with the doctor is a must.
Risk Involved In Surgery
Although, Scoliosis surgeries are safer and achieve better results, a surgery on the spine might induce certain risks. Following are a few to mention:
- Paraplegia - The highest risk associated with scoliosis surgery is paraplegia which is the loss of feeling and movement in the lower body and legs. It is hardly found but can result in devastating complication.
- Excessive Blood Loss – During the surgery a lot of muscle is stripped and area is exposed during the surgery, which resultsin blood loss.
- Other Risks – Sometimes, the spine may not fuse (also called pseudoarthosis) or there may be chronic Infection, leakage of cerebrospinal fluid, instrumentation failure (breaking of rods or hooks/screws may be dislodged).
Cost of Treatment For Adolescent Idiopathic Scoliosis
The following factors determine the cost involved in Adolescent Idiopathic Scoliosis:
- Hospital that patient chooses for his/her treatment
- Fees for the visiting specialist
- Cost of medicines
- Cost of tests and diagnostic procedures
- Cost of surgery
- Cost of follow-up care