Progressive
deformity and dissatisfaction with appearance are also important concerns
for patients and family members. At least half of all adults with
scoliosis identify dissatisfaction with appearance as the reason for
seeking surgical care. Accurate data on the psychosocial effects of
scoliosis and deformity on self-image and social role are limited, and
largely individualized. Long-term studies demonstrate a poor correlation
between the location or degree of a curve and the extent of psychosocial
complaints. For patients with AIS, the influence of surgery for deformity
on self-image and satisfaction with appearance varies and is difficult to
predict. Surgical treatment of deformity does not have a reliable effect
in improving self-image or satisfaction with appearance.
Neurologic
Compromise
Progressive neurological
deterioration is not characteristic of adolescent idiopathic scoliosis,
and development of late parapelegia is extremely rare. Degenerative
changes of the spine associated with adult deformity may lead to
progressive radicular pain patterns or to spinal stenosis. Congenital
deformity and scoliosis due to neuromuscular syndromes are characterized
by progressive neurologic deterioration with curve progression. The
presence of a neurologic abnormality with scoliosis will alert the care
provider to look for an intraspinal abnormality as neurologic disturbance
is not a characteristic sequelae of idiopathic scoliosis.
Surgical Techniques
Surgical techniques
continue to evolve in the management of scoliosis. For certain curve types
the surgeon is able to gain significant curve correction while preserving
much of the mobility of the spine. Minimally invasive techniques also
allow us to minimize the morbidity of anterior approaches to the spine. In
considering early surgical management options for AIS, one advantage is
the availability of techniques for minimizing fusion levels that may not
be useful in later stages of the deformity. Again, patients and families'
discussion with the care provider should include an understanding of
whether continued non-operative care may compromise future surgical
options.
Conclusion: Choices
in the management of AIS should be made with participation of the patient,
family, and care provider. The goal of this article is to outline a few of
the topics that are important in considering management options, and to
encourage the readers to pursue more information with their care
providers. Without information, choices cannot be made, and management
becomes prescribed. Ultimately an informed patient who participates in
management decisions is most likely to be satisfied with the outcome of
management.
