Scoliosis is a disorder of the spine.
It's a disorder in which the vertebrae actually rotate, and a curve is created either in the upper or the lower back
There is no unified theory to the cause. 80% of Scoliosis cases are Idiopathic and the cause for this is unknown.
Idiopathic Scoliosis: Unknown Cause
Neuromuscular Scoliosis: Caused by a Neuromuscular Disorder
Congenital Scoliosis: Born With a Bony Abnormality in the Spine
Scheuermann's Kyphosis: Front of Vertebrae Wedge Causing "Roundback" Deformity.
Hyperlordosis: May Have Either A Muscular Cause or May Be Caused From A Bony Spinal Abnormality.
Scoliosis is thought to be genetic. It's a result of expression of multiple genes, but it has something that's called variable penetrance, meaning that in each generation there is variability in how strongly the genes are expressed, that is, how severe the curve is. A valid question to ask is: Can it be passed on? Is it something that runs in families? And the answer is yes; scoliosis can run in families.
Children can get scoliosis as a result of a spinal cord injury. One of the categories for scoliosis -- one of the causes -- is a degenerative neurological condition that affects some unfortunate children. The other source can be trauma. Some children can develop Scoliosis from a car or motorcycle accident and as a result of loss of the normal muscle control in the spinal cord; they then develop a deformity, which is secondary to their spinal cord injury.
Polio was one of the most common neurological causes of scoliosis. Certainly in the '30s, '40s and '50s, when the great epidemics of polio on this continent occurred it was very common to see children with scoliosis.
The vast majority of patients with Scoliosis fall under the category of Idiopathic Scoliosis. But there are those cases, which are Neurological, where there's some kind of spinal cord or brain injury, cerebral palsy, and poliomyelitis -- any one of these neurological disorders. And there's trauma -- an induced spinal cord injury.
There are Congenital abnormalities of the spinal cord and of the vertebrae, which lead to Scoliosis. And finally there are the so-called developmental abnormalities. My way of describing them is that there are component parts which are made wrong during early foetus development -- either the vertebrae are congenitally malformed or congenitally fused together, leading to very severe curves, or the underlying spinal cord is made incorrectly. And in some of these situations research is being carried out for links to drugs, medications, environmental features, environmental causes, which put children at risk when they are in the mother's uterus.
A: I understand your confusion. On the surface the word orthopedic would seem to indicate that orthopedics surgery is a surgical specialty that only treats children. It would seem so since the word orthopedic comes from the Greek words "orthos" meaning straight, and "pais" referring to children.
However, the field is focused on treating all musculoskeletal conditions, for both adults and children. The word orthopedics is credited to Nicholas Andry, who in 1741 wrote a book called "L'Orthopedie, ou de Prevenir et de Corriger Dans les Enfants, les Difformités du Corps" (Orthopaedia, or the Art of Correcting and Preventing Deformities in Children).
This book described the diagnosis and treatment of childhood musculoskeletal disorders such as polio, scoliosis and fractures. So early on orthopedics was focused on treating mainly childhood musculoskeletal diseases but has since then grown to cover the full spectrum of musculoskeletal disorders for both adults and children.
Initially surgical treatments of musculoskeletal disorders were limited in their scope to small procedures until the advent of anesthesia and antibiotics. The widespread adoption of these two advances made it easier to perform more complex procedures.
Orthopedics not only deals with the surgical management of musculoskeletal disorders but also the nonsurgical management. The nonsurgical treatment often utilizes medications, physical therapy and bracing. Initially general surgeons performed most of orthopedic surgery but as the science improved and the procedures became more complex the specialty of orthopedic surgery developed into its own.
Currently there are many sub-specialties within orthopedics surgery. These include hand surgery, joint (hip, knee, shoulder) replacement surgery, trauma surgery, sports medicine, spine surgery and of course pediatric orthopedic surgery.
The opinions expressed solely are those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon click here to email him. If you prefer you can write to him at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Reader should seek specific medical advice from their own physician.
Scoliosis is thought of as being a childhood disease. And were generally taught that it was such. And in fact, most commonly, Scoliosis presents in the boundary between the juvenile and the adolescent stage -- 9, 10, 11, 12 years of age. There is, however, adult onset or degenerative scoliosis, which is thought to develop as a result of disk degeneration, and probably is an entirely separate entity from what we commonly think of as Adolescent Idiopathic Scoliosis.
The incidence of Scoliosis in men and women is approximately the same. What's very interesting, however, is that if you are female and you have Scoliosis as an adolescent or young adult, the progression rate is seven to eight times more common among girls than it is among boys. And that fact is completely unexplained.
Information about Scoliosis is changing. The accepted teaching used to be that once you reach adulthood, the curves become static and do not progress. And for most patients, that may still be the case. However, a curve more than 50 degrees continues to increase during adulthood, “normally” patients with a 50 degree curve or more progress on average 1 degree per year, even after surgery. Their doctor monitors curves of less than 30 degrees every 6 months and the curve is tried to be kept under control through bracing and other methods.
Scoliosis surgeries are complex, and there are many steps to each operation. The operation in children takes from two to three hours. In adults it takes a little longer, from about four to six hours, of course this all depends on the type of Scoliosis and the degree of the curve.
Adults do sometimes need more than one procedure. That is, they need some kind of procedure done from the front and from the back at the same time. Sometimes this can be done in a single combination operation, but other times it is best to separate the process into two procedures. I do however, know people that have suffered 6+ Scoliosis correctional surgeries.Join our Scoliosis support group and speak to those who have experienced more than 1 Scoliosis surgery
After a routine Scoliosis surgery patients are admitted to the intensive care unit where there is focused nursing care. It really is very comforting for both the patient and the family to know that there's one nurse who is completely attentive to their needs. One of the things that are paramount is the appropriate management of pain. For pain a catheter is used, up against the spinal cord and narcotics are pumped directly onto the cord. The day after surgery some patients may actually sit in a chair and take one or two steps. By the third day they’ll stand and walk, and by the fourth day will often be walking in the halls. After discharge, which is routinely on the fifth day, patients from out of town (and many from in town) are sent to the rehab hospital to spend another week regaining their abilities to do all of the activities of daily living.
After surgery, some patients need a brace. Modern braces are light thermo-plastic so they're easily put on and taken off by the patient. You don't have to sleep in them. You don't have to bathe in them. And you wear them for about three months. It's a far cry from the casts that individuals were put in years ago and even more so after surgery, years ago patients were in hospital for 2 weeks on what was once called the “Stryker Frame” (and is still used in Bangladesh).
There is the first week leading up to discharge from the hospital. And when a person can walk again and is eating regular food and putting on and taking off their brace, they really feel that they've made a great step forward. Probably the second big milestone is discharge from rehab, and that's typically about two to two-and-a-half weeks total time from surgery. The next big independence is driving. Some patients start to drive as soon as a month. Three months to 6 months seems to be when many people really regain control of their own lives. Many people go back to work about five weeks after surgery in a light-duty capacity. However patients should be seen by their surgeon a year post op.
Pain is a terribly disruptive phenomenon in someone's life. Pain disrupts your personal emotional life. It disrupts your relationship with your spouse. It disrupts your relationship in your work. It disrupts the relationship with your children. Pain can really ravage your life. So surgical procedures can help with pain.
Scoliosis treatment technology has changed very rapidly and there are ways to treat these patients now. Unfortunately, there is a big information gap between the primary care physicians and the specialists around the country who treat Scoliosis. The reality is that in the 21st century that Scoliosis in adults can be treated and very effectively.
That’s a very common concern: "Will my insurance cover the treatment?" Scoliosis surgery is an appropriate medical treatment and so it is covered by insurances. (Mainly US patients as we have NHS in the UK).
There's been a dramatic explosion in the amount of research that is done on Scoliosis, both basic science and research into the cause of scoliosis and the clinical treatment. The medicine world is learning more and more about the fundamental molecular, genetic, and foundational causes. The future of Scoliosis treatment lies in early genetic diagnosis, and biopharmaceutical treatment of the growth abnormalities that lead to curvature of the spine. I would hope in the future that we unlock the secrets of predicting which child will have a progressive curve, and more importantly, having pharmaceutical or genetic treatments that would really get rid of the need of implanting metallic hardware in individuals' bodies to correct their curves.
Scheuermann's kyphosis is a problem with bone formation in the spine. This defect results in wedging of the vertebral bodies. The wedging of the vertebra in turn results in the condition of kyphosis, an abnormal curvature of the spine. Scheuermann's kyphosis is most commonly diagnosed in adolescents at the time of puberty. It is thought to run in families, but this relationship has not been well demonstrated. Factors such as height and weight are also thought to be possible contributing factors. Treatment usually begins conservatively, and often Scheuermann's kyphosis resolves at the end of the adolescent's rapid growth. Treatment with a brace is sometimes used. Surgery is rarely needed to treat Scheuermann's kyphosis.
A compression fracture occurs when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This injury tends to happen in two groups of people. First, are patients who are involved in traumatic accidents. When a load placed on the vertebrae exceeds its stability, it may collapse. This is commonly seen after a fall. The second, and much more common, group of patients are those with Osteoporosis. Osteoporosis is a condition that causes a thinning of the bone. As the bone thins out, it is less able to support a load. Therefore patients with osteoporosis may develop compression fractures without severe injuries, even in their daily activities.
Back pain is by far the most common problem in patients with a compression fracture.
Osteoporosis is a condition that causes thinning and weakening of normal bone. The definition of osteoporosis is a decrease of the density of bone mass. When this occurs, a patient with osteoporosis will have weaker bones and have a higher risk of bone fracture. Osteoporosis is not arthritis, which leads to problems within joints due to cartilage wear. Instead, Osteoporosis is a problem of the bone, and its ability to adequately support the weight of your body.
There are two main categories of osteoporosis, Type I and Type II. Type I Osteoporosis occurs only in post-menopausal women, and is due to estrogen deficiency. Type II Osteoporosis occurs in both men and women (about two times more frequently in women), and is due to aging, and calcium deficiency over many years.
As people age, the amount of bone in their body steadily decreases. Women are especially prone to developing thin bone because they don't develop as much bone while younger, and the rate of bone loss in women is greater than men. Because of this, age and gender are the most important risk factors for developing osteoporosis. Both men and women achieve their "peak bone mass" in the third decade of life. After that time, bone mass gradually, but steadily decreases. In pregnant and lactating women, the rate of bone loss will temporarily increase if the increased calcium demands of pregnancy or breastfeeding are not met by increased dietary intake of calcium. In women, there is also a significant decrease of bone mass in the immediate postmenopausal period. Other important risk factors that can contribute to developing osteoporosis include Northern European ancestry, hypothyroidism, anticonvulsant medications, and a sedentary lifestyle. Americans are especially prone to developing osteoporosis, the exact cause of this is not known. It is known that this is not entirely related to ancestry, as studies have shown that individuals who immigrate into the United States from other countries develop an American's higher risk of osteoporosis.
Until the last few decades, patients undergoing Scoliosis surgery endured intensive surgery, treatment and casting, as well as months of slow recuperation. Since that time, spinal surgery pioneers such as Paul Harrington, Yves Paul Cotrel and Jean Dubousset have made great strides in improving the techniques and instruments used in surgery and post-operative care for patients with Scoliosis. There are different techniques and methods used today for Scoliosis surgery. The most frequently performed surgery for Adolescent Idiopathic Scoliosis involves posterior spinal fusion with instrumentation and bone grafting. This kind of surgery is performed through the patient's back while the patient lies on his or her stomach. Two common instrumentation techniques are called Cotrel-Dubousset instrumentation (rod rotation technique) and Colorado instrumentation (translation technique). During these types of surgery, the surgeon attaches a metal rod to each side of the patient's spine by using hooks attached to the vertebral bodies. Then, the surgeon fuses the spine with a piece of bone from the patient's hip (a bone graft). The bone grows in between the vertebrae and holds them together and straight. This process is called spinal fusion.
The metal rods attached to the spine ensure that the backbone remains straight while the spinal fusion takes place. Surgery is an option used primarily for severe scoliosis (curves greater than 45 degrees) or for curves that do not respond to bracing. There are two primary goals for surgery: to stop a curve from progressing during adult life and to diminish spinal deformity. Another surgery option for Scoliosis is an anterior approach, which means that the surgery is conducted through the chest walls instead of entering through the patient's back. The patient lies on his or her side during the surgery. During this procedure, the surgeon makes incisions in the patient's side, deflates the lung and removes a rib in order to reach the spine.
This approach allows the surgeon to operate higher up in the spine than through posterior approaches, and studies have shown favourable results with this type of surgery. Video-assisted thoracoscopic surgery allows surgeons to enhance their vision of the spine and to conduct a less invasive surgery than with an open procedure. The anterior spinal approach has several advantages: better cosmetic results, quicker patient rehabilitation, improved spine mobilization, and fusion of fewer segments. Most patients require bracing for several months after this surgery. To further explore techniques for scoliosis surgery and to decide which surgery is best for you or your child, consult a specialist.
Bone, which is harvested from one location in an individual and placed in another individual (allograft bone) or in a different location in the same individual (autogenous bone).
Bone taken from your own body is called autograft. Bone graft taken from someone else is called allograft. Allograft is usually removed from organ donors and placed in bone banks. The bone bank follows procedures intended to sterilize the bone graft and performs tests on the bone for diseases such as hepatitis and AIDS (just like a blood bank). The bone bank then sells the allograft to the hospital that performs your surgery. An allograft can come from many types of bones in many different forms, but because it is not taken from the patient, it does not contain any living cells and has fewer chemicals to stimulate growth of new bone. The disadvantage of an allograft is that it does not always heal as well or as quickly as an autograft. However, a bone-growing protein can be added to the site to make up for the lack in the bone graft. The advantage is that the patient does not have to donate the bone graft, so the surgery is shorter, and there may be less postoperative pain. The allograft also carries a risk of transferring infectious diseases, although it is rigidly tested.
Allograft is very useful when the operation will require more bone graft than your own body can supply. Some major spine fusions need a lot of bone graft and the surgeon may mix allograft with autograft. Some surgeries need large pieces of structural bone graft and it would cause a problem in the area where the bone was removed if it were taken from your own body. There has been a great deal of research to design bone graft substitutes, chemicals, and devices that can stimulate the bone to fuse and grow together. Electrical current has been known for some time to stimulate bone to grow, so many surgeons use electrical stimulation devices during the first weeks of surgery to speed up a fusion. Artificial bone graft materials have been developed. Sea Coral, harvested from oceans, has actually been used as the basis for a structural bone replacement very successfully.
The technique of doing a discogram is to sedate the patient, although the patient is still awake, insert a needle into the disc space under fluoroscopy and inject the disc space with contrast material. The purpose is to see the volume of material the disc will accept, the pattern of the contrast material on x-ray image and, most importantly, the sensation of the patient as the injection occurs. In general, the injection is painless or is described as a pressure sensation. If the injection reproduces the same discomfort as the patient feels at home, then it is an indication that the level being injected is the source of the pain. If every level that is injected hurts, there is not a surgery to fix it. If no level hurts, then you must look further for the source of the pain.
Spondylolysis is a defect in the pars interarticularis of the vertebra. Spondylolisthesis is the translation or slippage that occurs through this defect. About 5% of the general population have a spondylotic defect or a spondylolisthesis in the lumbar spine. This is the most common type of spondylolisthesis. Spondylolisthesis can also occur as a result of degenerative changes, trauma, tumour, congenital changes or postoperative instability. The treatment for pain due to spondylolisthesis is activity modification, anti-inflammatory drugs and pain medications when needed. If the pain is intractable or associated with a neurologic deficit, the most common one would be L5 or S1. Problems such as weakness of the calf muscles when tiptoeing or the dorsiflexors of the ankle when walking on the heels or pain and numbness in the big toe (L5) or little toe (S1) may occur. Physical therapy, isometric exercises to strengthen the trunk, and avoidance of activities that require extremes of motion of the back are recommended. We discourage hyperextension as associated with diving, gymnastics, football lineman maneuvers. If surgery becomes necessary, the indications would be obvious progression of the slip, intractable pain or neurologic deficit. Reduction is possible.
Hospitalisation is usually three to five days. Patients return to sedentary activities in the workplace within a month. Most patient’s get as good as they are going to get within four to six months of the surgery. The recovery depends on the preoperative aerobic conditioning of the patient.
Be sure to discuss the different options with your surgeon.