http://bit.ly/jEEl6b Children and adults require different approaches for the treatment of scoliosis. The range of scoliosis treatment options can include braces, physical therapy and exercise programs, and for severe cases, scoliosis surgery. In addition to age considerations, the treatment options are also based on the degree of spine curvature deviation, the level of pain and medical improvement goals. This scoliosis video, presented by Drs. Thomas Kula and John Lettice, covers the following informative topics: scoliosis surgery and non-surgical treatments for children and adults, selecting a spinal surgery program and an inspiring patient success story.
Normally, if you look at the spine from the front view like this, all these vertebrae should line up and the spine should be straight. You can see here that there are actually two curves; one in the middle part of the back, the thoracic spine, and one in the lower part of the back, the lumbar spine. Typically, any curvature that deviates for more than 10 degrees is considered to be scoliosis.
In most of the patients, the curve is not progressive and we just observe the patient to see if the curve is going to progress. When the curve gets to be more than about 20 or 25 degrees and the patient still has growth potential, we may then recommend the use of a brace in order to prevent that curve from getting worse while the spine is still growing. When the curve gets to be more than about 45 degrees, the curve is beyond the level that we can treat effectively with a brace. That's when we think about the surgical option.
In the adult patient, it really depends upon the problem that the curve is causing. Is it pain in the back? Is it pain in the legs? Is there evidence that the curve is getting progressively worse, and how big is the curve? In the adult patient we don't use braces. We may suggest other non-operative treatments like physical therapy/exercise programs in order to try to improve the condition of the spine. But when those treatments fail, then we look for different surgical options.
Typically for children, the goals in surgical treatment are to halt the progression in the spinal deformity and correct the deformity to a neutral spine or a balanced spine. That's typically accomplished with a screw-rod construct that is placed through a posterior incision through the back.
In contrast to the adolescent, in the adult the scoliosis usually involves not only the thoracic spine but also the lumbar spine, as demonstrated by this radiograph whereby you can see a large curve involving the chest spine here and then the lower back. More significantly, you can see narrowing of the chest cavity at these levels. This results in shortness of breath. Post-operatively, you can see that there's restoration of balance utilizing the pedicle screw-rod construct all the way throughout the curve from the upper thoracic spine to the lower back to the lumbosacral junction, and also an improvement in the pulmonary or lung volumes of this patient.
I think you have to look at how much experience the surgeon has, particularly in dealing with the more complicated problems. Spinal deformity is a more complicated problem than some of the other more common back disorders and people may experience back or leg pain. The more experience that somebody has, generally the better their outcomes are. Dr. Lettice and I have been doing this surgery for over 20 years working together, and we actually work as a team. We're both there in the operating room on either side of the operating room table while we're taking care of the patient.
We operated on a young lady who had a phenomenal amount of opiate intake just to allow her to perform her activities of daily living with her children. She's now two years post-operative and she's off of all of her pain medication, and essentially has a full and really unrestricted lifestyle now.
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