Surgical and
Curve Considerations
- Double "S" curves may require
fusing both curves.
- Sometimes a selective fusion of
only one curve can be done.
- Selective fusions require that one
curve be relatively flexible; therefore, it does not need to be operated
on.
- If a selective fusion is
performed, the second curve will be closely observed. If the second
curve becomes larger, it may be treated by bracing (growing children) or
may require surgery at a later time.
- The advantage of a selective
fusion is that more motion segments are preserved than when more than
one curve is fused.
Selective Fusion (below):
Correction of the thoracic curve results in partial correction of the
lumbar curve without fusing most of the lumbar
spine.
- Large, stiff (rigid) curves may
require a combined front and back (anterior-posterior) surgery.
- Front and back surgeries are
either performed on the same day or are staged to be performed as two
separate procedures several days apart (sometimes longer).
- Occasionally, a rigid severe curve
can be addressed all from a posterior approach with a procedure termed
"vertebral column resection".
Rigid Curve (below): The
bending x-ray shows very little correction of the thoracic curve revealing
its stiffness.
Patient's Age
The patient's
age is a general consideration. For example, older patients have more
arthritis and degenerative changes affecting the spine's discs than
younger patients. Curves tend to be more rigid in adults and more flexible
in younger patients.
Crankshaft phenomenon (the front part
of a fused spine twists as the spine grows) can occur in patients who are
skeletally immature. This is more common in patients under 10 years of
age. Other considerations include:
- Adults tend to have softer bone
because of osteopenia or osteoporosis.
- Adults are more likely to have
disabling or limiting pain related to their
scoliosis.
- Adult surgeries usually take
longer to perform and recovery is longer than a
child's.
