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When should a person consider scoliosis surgery to straighten a curve? It’s a complex decision, because waiting too long carries increasing risks. That’s because the spine is most flexible — and more receptive to correction — when the person is under 21 years of age. As a person gets older, the spine is less flexible and the scoliosis surgeon must be careful to not over-correct which could cause damage to the spinal cord and cause paralysis. Advances in spinal deformity surgery has produced new instrumentation and fixation devices that untwist the spine. A surgeon trained in mini-scoliosis surgery accesses the spine through several shorter incisions rather that one long incision. This lessens the disruption to muscles and ligaments and speeds recovery.
There are roughly three tiers of treatment for adolescent scoliosis. General scoliosis treatment options include observation, bracing, and if the curve is large and progressive, surgery. Patients with pain and function issues can be treated with therapy, as well as physiatry (physical medicine and rehabilitation physician-supervised programs). Sometimes, shoe inserts (orthotics) are prescribed for those whose legs are uneven.
For adults, the emphasis is on function and movement. Bracing is used only as a temporary pain relief measure; it cannot correct the curve in an adult. Treatment focuses on medications and physical therapy. If other problems exist that are caused by the scoliosis (sacroiliac dysfunction, flatback, spinal stenosis, nerve root pinching), there are many non-operative treatments for each of these issues.
Surgery may be required in order to correct the spinal curve. Surgery is usually only recommended for large, progressive curves or in those patients who have nerve pain that steadily worsens. These surgeries can be extremely complicated, and a person should invest a great deal of time in selecting a spine surgeon who subspecializes in using the most current (fourth generation) corrective techniques. As with any spine surgery, finding a doctor with experience in this specific type of surgery is key.
As with any disease, the sooner the problem is discovered, the more treatment options there are available to arrest the progress of the condition.
When surgery is necessary, the concern with adults is that the older the patient, the less the flexible the spine is for correction, and the more risk for spinal cord damage during correction. In this case, waiting years to deal with progressing scoliotic curves can be a disadvantage.
Surgery consists of using metal rods, screws or wires to de-rotate the curve. An incision is made in the back so the surgeon can access the vertebrae and install the necessary instrumentation, rods, hooks and screws.
Scoliosis surgery is based on a two-rod instrumentation system with hooks that attach to each vertebral level, to de-rotate and straighten the abnormal curve.
Over the last five years, new minimally invasive scoliosis surgery has emerged that enables a scoliosis surgeon to make several shorter incisions to access and straighten the spine, rather than one long incision. This enables the patient to have a faster and less painful recovery.
The good news about scoliosis is that the vast majority of people diagnosed with some degree of scoliosis will often live normal, active and healthy lives.
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