PROCEDURES SAN FRANCISCO
What is Scoliosis?
The abnormal curving of the spine is known as scoliosis. If you take a look at the image of any back, you will see it has a natural curve to it. The difference with the backbone of a patient with scoliosis is that there is excessive spinal curving. Before puberty, usually between the ages of 9 to 15, there is a growth spurt, and this is typically the time that scoliosis develops. The majority of cases are idiopathic where the cause is unknown. However, it can also be congenital, hereditary, or as a result of an underlying neuromuscular condition such as cerebral palsy or muscular dystrophy. While scoliosis develops in both males and females, those cases found in the female population are more likely to require treatment.
The symptoms can vary dependant on the severity of the spinal curve. In mild cases, there may be no apparent symptoms apart from the irregularity of the spines appearance. In worse cases, such as those where the spine twists, patients may experience, and in severe cases may require treatment. Symptoms of scoliosis include:
- Lower back pain
- Extreme fatigue
- Difficulty breathing
What are the Different Types of Scoliosis?
Several types are commonly seen:
Adolescent Idiopathic Scoliosis (AIS) – Some patients develop scoliosis in childhood. If it is developed before age 10, usually it is called juvenile onset. If it is developed after age 10 but before skeletal maturation, it is usually called adolescent idiopathic scoliosis (AIS).
Congenital Scoliosis – Occasionally, there are some conditions that result in scoliosis to be present at the time of birth; this is called congenital scoliosis; it usually results from the bone not forming properly (failure of formation) or the spine not segmenting properly (failure of segmentation).
Adult-Onset Scoliosis – In adults, another form commonly seen is what is called adult-onset scoliosis, which usually results from advanced degeneration and asymmetric disc space collapse. Even though the vast majority of adult-onset involves the lumbar spine, occasionally we do see primarily thoracic scoliosis that might have been present in adolescence or childhood that has progressed due to superimposed degeneration.
The majority of scoliosis is treated nonsurgically; however, in adulthood, some patients do require surgery. The two most common indications for surgery in an adult are a progression of the deformity or significant pain unresponsive to conservative management. If surgical treatment is undertaken, usually very careful planning is necessary.
Diagnosis of Scoliosis
Diagnosis frequently involves obtaining cross-sectional imaging studies to visualize the status of the spinal cord and the nerve roots. These images may be obtained through an MRI scan or CT scan, or a CT myelogram. Often, measurement of the bone density of the patient is also required.
At San Francisco Spine Surgeons, we do obtain special scoliosis radiographs, also known as a long-standing film or 36″ cassette film. This provides invaluable information about the balance of the spine in both the frontal plane and the side plane and assists in presurgical planning. If surgery is contemplated, normally we require a CT scan for robotic guidance.
We are proud to offer the Mazor Renaissance robotic guidance system that we have used at St. Mary’s for over a year in more than a hundred cases. The surgery itself is usually quite lengthy and quite involved. It requires the participation of an experienced surgical team. We have been doing surgical correction of scoliosis at St. Mary’s Hospital for almost three decades and have an extremely experienced team of surgeons, surgical assistants, anesthesiologists, scrub technicians, and nurses both in the operating room and on the surgical wards.
A young nurse with neurofibromatosis.
The surgery for correction of scoliosis in adults typically is much longer and much more involved than surgery in adolescents or children and may take anywhere from six to twelve hours. As part of the surgery, occasionally it is necessary to remove part of the bone and performed so-called osteotomy to improve surgical correction. Another part of the procedure is the placement of instrumentation or pedicle screws; this frequently is done with the assistance of robotic guidance or fluoroscopic guidance.
The next part of the surgery involves placements of the rods and corrective maneuvers. At times, decompression of the neural elements (spinal cord or nerve roots) is required. After the surgery, patients at times need to go to the intensive care unit. The hospital stay after surgical correction of spinal deformity can be anywhere from three to ten days. Postoperative bracing sometimes is required.
Severe Juvenile Scoliosis Before & After