SCOLIOSIS
Introduction Scoliosis is the term given to abnormal lateral curvature of the spine when looked from front or back. If diagnosed early then it could be treated conservatively through bracing and therapeutic maneuvers. For some cases the curve is significant enough which should be operated through screws and rods so as to correct the deformity. Most commonly scoliosis is idiopathic in nature i.e. the exact cause behind it is unknown. It is seen in adolescence commonly hence also termed as "adolescent idiopathic scoliosis" Scoliosis is more common in girls than boys. Another form of scoliosis is seen in adults termed as degenerative scoliosis. Mainly occurs due to senile osteoporosis due to depletion of calcium stores and thus weakening of the spinal bones leading to bending of the spinal column. What are the causes of scoliosis? Generally the causes of scoliosis are divided into the following categories- Neuromuscular or paralytic curves Congenital curves i.e. by birth Due to disease, tumor or trauma Idiopathic i.e. the cause is unknown. What is the procedure for surgery? It is major spine surgery. The primary aim of surgery is to correct the deformity. It is most commonly done from behind. Infantile scoliosis may be treated with instrumentation without fusion in the form of a growth rod technique. As the age progresses, the rods that are implanted are distracted at an interval of 6 months till the final growth is achieved at puberty. These patients commonly go on to have a permanent fusion with instrumentation as a final treatment modality. If the puberty is already achieved then we go for fusion of spine as already the maximum height is achieved. Is there any alternative to the surgery? If the deformity is not severe and not progressive in nature we can try and maintain the curvature through braces or orthotic devices. The curvature can be prevented to progress further but cannot be corrected through the orthotic devices. But if the deformity is severe and is impinging on the organs then surely surgery is only available option left.
How much time is required for surgery? It takes around 4-5 hours to perform the surgery depending upon severity of the curve. How much time do I need to stay in hospital? One day before surgery you need to be admitted in the hospital so as our team can perform the essential tests required before surgery. And you will be discharged on the 5th or 6th day depending upon your general health condition. Do I need to perform any test prior to surgery? Yes, there are a set of test known as PAC (Pre Anesthetic check up) that you are required to undergo before surgery so as to be declared FIT for surgery by the anesthesia team. Is it necessary to undergo the surgery immediately? Generally it is advisable to go for the surgery at an early stage if the deformity is severe or the child is going off balance so that maximum correction can be achieved with growing rod technique. But if the deformity is not severe, we ideally wait till the puberty is achieved so that maximum skeletal maturity is gained. If scoliosis correction is done once the puberty is achieved then spinal fusion or arthrodesis is done. Is there any contraindication for surgery? If the curve is rigid and fused generally it is not advisable to operate as the complications of paralysis increases. If the co-morbid condition of patient is not optimum then it is advisable not to undergo surgery. How much incision will be left after surgery? The incision size depends purely upon the curvature of the spine. Usually the level where the correction is done is incised completely as we need to fix up the bones. It is a major surgery with larger incision usually on the posterior approach. Sometimes an anterior approach is also used depending upon the surgeons' decision. Will the surgery be performed under local or general anesthesia? This procedure is done under general anesthesia.
What are the Risks and Complications of Scoliosis surgery? The common complications are- Chest complication, nausea and vomiting due to the side effect of anesthesia. Infection may occur as a complication. Bleeding may occur from the incision site Wound dehiscence. Dural tear may occur, leading to CSF leakage. Bowel/bladder incontinence may occur. Nerve root damage. Para-paresis or paraplegia may occur. Scarring of the skin may occur. Pre-op Back Post-op back What is the success rate? The success rate for normal curvature after surgery ranges 70-80 percent, depending upon the procedure, levels and patients' health condition. What will happen if I leave the deformity untreated? Spinal deformity will occur along with: Increase in deformity as the child grows Decrease lung compliance and respiratory disorders Injury to nerve leading to paraplegia.
Will I be paralyzed after the surgery? There is 6-8% known complication rate of paralysis even after the surgery is successful. The most common complication is Paraparesis or paraplegia post surgery. How much will be the cost of the surgery? Usually the surgery will cost from 4 Lakhs to 7 Lakhs depending upon the deformity and its correction. What are the restrictions that I need to take following surgery? Proper wound care; keep the wound dry and clean. Restriction from bending, lifting, or twisting for the first six weeks following surgery. Wear a belt post operatively. Advised not to lift heavy objects for 12 weeks following the surgery. How much time brace is to be worn after surgery? The patient has to wear a brace for at least 4-6 weeks. One has to wear the brace as long as 12 weeks sometimes. When do I have to come back post surgery? Usually you have to come after 2 weeks post surgery for stitch removal. You are required to see the surgeon if any of the below mentioned symptoms may occur- Fever Any inflammatory signs such as redness, swelling etc. Any drainage or blood oozing from incision site. Severe backache. Any numbness or tingling. Can I have bath after going back home? No, you have to keep the wound clean and dry till the stitches are removed. Do I need Post operative Rehabilitation or therapy? Yes you need to under go physical therapy under a trained physical therapist initially for-
Perform the activities of daily living, for ex. lying to sitting; to stand. General conditioning exercises. Deep breathing exercises. Gentle stretching and strengthening exercises. Understand the proper postural stability. When can I undergo the surgery? When you are mentally prepared for surgery, you can call and confirm the same to our team on the following numbers, so as to book the operation theatre and room for you- Mr. Rakesh - 9818855883 or Mr. Sandeep - 9899669547 You will be provided the tentative date for admission and surgery. Dr. Shankar Acharya M.S. (Ortho) FRCS (Glasgow) FRCS (Edin) M.Ch. (Orth) (Liverpool) FRCS (Orth) UK Spine Surgeon