1. How do I know if I have scoliosis?
Uneven
shoulders or hips, or asymmetry of the contour of the back (which is more
obvious with forward bending) can be visual tip-offs that scoliosis is
present. Also, individuals with a family
history of scoliosis are more likely to have scoliosis. Assessment by primary care physicians can
typically identify an individual with these types of body asymmetry and, if any
is detected, a single radiograph (x-ray) from the front/back of the thoracic
and lumbar spine (from collar bones to hips) is indicated to definitively
diagnose scoliosis.
2. Is there someone I can talk to who has scoliosis?
Yes, we can
connect you with other individuals (patients, parents, caregivers) who would be
willing to discuss the issues and problems of scoliosis on a first-hand basis.
3. Is scoliosis caused by not drinking enough milk or eating
too much junk food?
No, though
both of these may impact the long-term health of the spine by decreasing the
overall bone mass of the body. Low spinal
bone mass as an adolescent can become magnified in one’s 60’s, 70’s and 80’s
and can increase the risk of osteoporotic spinal fractures.
4. Does scoliosis hurt?
Mild scoliosis
does not cause pain. Moderate to severe
scoliosis can increase the likelihood of activity-related musculoskeletal pain.
5. Why do kids get scoliosis?
The cause
of “garden-variety” scoliosis is unknown.
Some researchers have found an association between scoliosis and a very
subtle form of neurological abnormality which has no outward manifestations
besides the scoliosis. Current research
is ongoing to identify the specific genes responsible for scoliosis.
6. What are the goals and expectations of scoliosis surgery?
The classic
type of scoliosis surgery is a spinal fusion.
In this surgery a segment of the spine is corrected to the optimal 3-d
alignment and then fused to eliminate motion between the vertebral body
segments. At the time of surgery the malalignment
of the spine is corrected as much as possible toward normal alignment. The use of spinal implants (metal screws,
hooks and rods) permits straightening of the spine and also maintains the
correction as the spine fusion heals after surgery. Newer techniques for correction of scoliosis
which do not “fuse” the spine are in the development (vertebral body tether and
Apifix) and early adoption phase and hopefully will decrease the need for
spinal fusions.
7. How much correction do you expect to achieve at the time
of spine fusion?
The amount
of correction depends on multiple patient factors: patient age, curve size,
location and flexibility, presence of other curves, concomitant medical
problems, previous surgery, etc.... Judicious
correction of the scoliosis is always indicated as overcorrection of the spine
can lead to temporary or permanent neurological injury, such as nerve root
deficits or paralysis.
8. How long will the incision be, and what can I expect in
terms of scarring?
For “open”
procedures, the incision will be made directly down the middle of the back. A “plastic surgery-style” closure is
performed with all of the sutures being under the skin, so no sutures have to
be removed after surgery. The sutures
gradually dissolve under the skin and are absorbed by the body. There is only “glue” on the skin, which falls
off about 3 weeks after surgery.
9. Which vertebrae will be fused in the "average"
scoliosis correction?
In the
“average” scoliosis correction in the thoracic spine the fusion starts at T3 or
T4 and ends at T12 or L1. If there are
thoracic and lumbar curves which need to be fused then the distal levels
typically are at L3 or L4.
10. Do you normally show the patient the hardware that you
will use in the surgery?
Yes, we have
plastic spine models with a typical scoliosis spinal construct which nicely
demonstrates the implants utilized during surgery.
11. Can you see or feel the hardware under the skin?
You cannot
see the spinal implants under the skin.
Occasionally a thin individual may feel a prominent implant under the
skin due to the decreased muscle mass or subcutaneous tissue to “pad” the
implants. Prominent implants are more
common when the fusion is continued to the pelvis with screws into the iliac
wings.
12. How much growth would you expect the fused portion of my
spine to have grown had it been left unfused?
The amount
of growth lost due to a spine fusion is typically 0.07 cm cm per level per
years of growth remaining. Females
typically complete growth by 14 years of age and males by 16 years of age. For example an average 12 year old female
with a spine fusion from T3-L1 would lose approximately 1.8 cm (2/3 of an inch)
of overall height.
13. What is a "crankshaft phenomenon," and when
does it occur?
This
phenomena can develop when a posterior spinal fusion is performed in an
individual who is less than 10 years of age.
The “crankshafting” occurs due to the arrest of posterior spinal growth,
due to spinal fusion, while anterior spinal growth continues causing the
previously fused segment of the spine to slowly twist into a more deformed
position with growth. Prior to the
development of thoracic pedicle screws, surgery was performed on the front and
back of the spine in younger patients to prevent “crankshafting”. With the use of thoracic pedicle screws, this
phenomena does not appear to occur due to the improved spinal fixation.
14. Would instrumentation without fusion be a better
alternative than fusion when growth potential is remaining? Ideally the answer is “yes”. Currently several U.S. medical centers
specializing in pediatric spinal deformity are researching various types of
“fusionless” scoliosis surgery, such as vertebral body tethering and Apifix. Early, preliminary reports from these centers
are encouraging but these are still in the developmental phase and indicated
only for very specific curve types.
15. What will I be given for pain after surgery? Immediately
after surgery, pain is managed with a PCA, which stands for “patient-controlled
analgesia”. By pushing a button you can
administer your own intravenous pain medication without the need of the nursing
staff. As intake of fluids and food improves
after surgery oral pain medications will be started and the PCA will be
gradually weaned off in preparation for hospital discharge. No injections are used for pain medication in
our hospitals after surgery. Opioid use
is minimized by using other medications to help decrease pain.
16. How often will I be awakened and checked by a nurse
after my surgery? The first night the
hospital staff will closely monitor vital signs. This means every several hours you may be
awakened, however all attempts are made to minimize intrusions.
17. When will I be able to get up and walk for the first
time after surgery? The first day after
surgery you will sit on the side of the bed to dangle of the feet, then stand,
transfer to a chair and then take a few steps.
Longer walking (in the hallway) is normal at 2 days after surgery with
the assistance of a physical therapist or nurse. Thereafter, walking is expected to be done a
minimum of 2 times per day.
18. How soon will I be able to eat and drink after surgery? Usually drinking of clear liquids (such as
water, sodas, etc…) can be started immediately after surgery. Since the stomach does not function normally
initially after surgery oral intake is limited, but is started the day after
surgery. Any type of food you want to
eat is perfectly fine, though salty, fatty, spicy foods are not usually
preferred by postoperative patients. The
day after surgery the intravenous pain medications are converted to oral pain
medication and since these medications can cause some nausea and vomiting,
eating some food can help significantly.
19. What will be done to make my back incision safe after
surgery? The initial postoperative
dressing which is applied in the operating room is removed, on average, at 3
days after surgery along with the surgical drains. After this time the incision is typically
left open to air without any dressing covering the wound. The incision should be kept clean and dry for
1 week after surgery.
20. Will I need physical therapy after surgery? Formal
physical therapy is started in the hospital for transfers and ambulation. However, after discharge from the hospital physical
therapy is not usually continued for the typical scoliosis surgery. In addition, bracing is not typically used
after surgery.
21. What are some types of therapy that I might have to
undergo? In the hospital the physical
therapist will assist and teach the appropriate methods for transferring from
bed to chair and to standing position.
Your ability to ambulate will be assessed and the therapist may
temporarily have you use a walker to help with balance. The great majority of patients walk fine at
discharge from the hospital and do not need a walker to go home.
22. Will I need a special type of mattress on my bed? No. Most individuals have an adequate mattress on
their bed. Occasionally a hospital bed
may be helpful if the physical environment at home makes use of the regular
bedroom and bed temporarily difficult.
23. How much experience will the person who is monitoring my
spinal cord function have? The spinal
cord monitoring team at our 3 hospitals consists of 8 full-time highly skilled
individuals who as a group monitor over 1200 surgeries per year.
24. What is a "wake up" test and when is it
performed? Essential to a successful
spine surgery is the absence of any adverse neurological outcome during or after
surgery. Spinal cord monitoring is
extremely accurate in identifying neurological deficits (>99%) during
surgery, but there are some individuals in whom spinal cord monitoring is
suboptimal or unobtainable. In these
cases, a “wake up” test is used in which the patient’s anesthesia is
temporarily lightened during surgery so that, while following verbal commands,
the arms and legs can be actively moved by the patient. After neurological function has been assessed
the patient’s anesthesia is deepened back to the routine level of
anesthesia. Due to the type of
anesthetic agents used, patients typically have no recall of the wake-up test
after surgery.
25. I want my rib hump corrected. How is this done? The correction of the scoliosis is achieved by
several inter-related techniques during the surgery which can also secondarily decrease
the rib hump. If the rib hump is perceived
as a significant part of the overall deformity a “derotation maneuver” can be
additionally performed which directly corrects the abnormal scoliotic spinal
rotation and thereby decrease the rib hump significantly.