Frequently Asked Questions about Scoliosis: |
How
do I know if I have scoliosis?
Scoliosis or curvature of the spine commonly produces
a cosmetic deformity. Visible asymmetries in the contour
of the back and the observation that one shoulder or hip
is higher than the other are the most common signs that someone
has scoliosis. These asymmetries are more pronounced in adolescence
during rapid growth spurts and may be detected by parents
or friends.
Adults, who have not suspected that they have a curvature of the spine, may realize
that they are rapidly losing height which could be an indication of a progressive
curvature of the spine. Direct examination by a qualified orthopedic spine surgeon
and confirmation by x-ray will confirm the presence of scoliosis in an adolescent
or an adult. |
Is
there someone I can talk to who has scoliosis?
Discovering that you have scoliosis may be frightening.
Once patients understand that curvature of the spine is
not rare (approximately 3% of the population has a curve
of 10° or more), they accept being followed by a qualified
physician to monitor the curvature for progression. Information
about scoliosis and its many variants is readily found
in bound reference material and on the Internet www.eSpine.com/scoliosis2.html
The primary source of information on scoliosis and curvatures
of the spine should be obtained by a qualified orthopedic
spine surgeon. Many patients find that speaking to a similar
aged individual who is also dealing with scoliosis can
be comforting.
In my experience, patients especially appreciate speaking to other patients about
their post-operative experiences and the timeline for their recovery. Routine
activities of daily living in the post-operative period are best communicated
between patients. In my practice, if the patient is scheduled for surgery, arrangements
are made for other patients that I have treated to speak to the patient about
many issues. All over the country and in every community there are scoliosis
organizations that have meetings to discuss common experiences and issues related
to scoliosis. The National Scoliosis Foundation,
Inc. and the Scoliosis Association, Inc are
two of the largest associations.
Pam Douglas is a patient who underwent surgery for Adult Idiopathic Scoliosis. Pam wrote a book "Back To Life" about her experiences. The book is very insightful and honest, and I'd highly recommend it. |
Is
scoliosis caused by not drinking enough milk or eating
too much junk food?
In extremely rare cases, scoliosis can be caused by dietary
issues. Scoliosis may be an infrequent finding in diseases
where calcium is lacking which causes softening of the bone.
What one eats and how much one eats does not produce curvature
of the spine. To my knowledge, junk food by itself has never
caused curvature of the spine. |
Does
scoliosis hurt?
Children
and adolescents who have scoliosis rarely complain of pain.
If pain is the major complaint in a young patient with
scoliosis, further analysis is needed beyond plain x-rays
to establish an underlying cause of the curvature. For
example, in rare instances a benign inflammatory focus
of tissue (osteoid osteoma) can produce curvature of the
spine.
The adult population diagnosed with scoliosis often seeks treatment because of
pain. As one ages, the spine becomes less flexible and undergoes changes which
reduce water content in the disks and produce inflammation in the joints. |
Why
do kids get scoliosis?
To answer this question it must be understood that scoliosis
falls into two major categories: idiopathic and non-idiopathic
scoliosis. Idiopathic is the more common type of scoliosis
and the one that is most commonly identified at the beginning
of accelerated growth in adolescence. Unfortunately, at this
time we have not established a single identifiable cause
for production of curvature of the spine in idiopathic scoliosis.
I have the honor of being a member of an international group
of physicians who have received grants from the Cotrel Foundation
of France to investigate the causes of idiopathic scoliosis.
To date, research has focused on genetics (based on the observation
that scoliosis can run in families), nerve and muscle abnormalities
(based on the observation that scoliosis can occur in patients
who have abnormalities of the nerves and muscles), central
mechanisms and abnormalities of the inner ear. My research
focuses on the finding that the fluid around the spinal cord
(CSF) flows asymmetrically in patients that have curvature
of the spine. That research is being carried on here at the
Cedars-Sinai Institute for Spinal Disorders in Los Angeles.
To read more about this research project, please click here. |
If
surgery is not an option, is wearing a hard brace the
only other choice to preserving the spine?
Although there is little controversy as to whether patients
who meet certain criteria should be braced, the exact choice
of the brace type and duration of brace wear generates
some debate. An excellent discussion of brace effectiveness
was summarized in Dr. Winter's article in Backtalk,
April 1999 (Volume 22/Number 1). (Produced by The Scoliosis
Association, www.scoliosis-assoc.org) |
Who
qualifies for spinal surgery (and who makes that decision)?
How bad does the curve have to be?
For a patient diagnosed with
Adolescent Idiopathic Scoliosis, who has never had spine
surgery, the main indicator for surgery is a progressive
curvature measuring 40° or more. The physician will recommend
surgery based on medical necessity (not cosmetic reasons),
and then surgical options are discussed with the patient,
and the parents of any patient less than 18 yrs. The decision
to proceed with surgery is in the hands of the patient. (And
the parents of any patient less than 18 years of age) |
Is
there an age requirement? (If so, is this a common age
that many spinal surgeons tend to go by)?
The decision for surgery is based
on medical criteria, including the degree of curvature,
the skeletal maturity of the patient, and the progression
of the curvature. Through surgical intervention, the spinal
curvature can routinely be corrected to 40% of the original
size, but the surgical goal should more importantly be
producing a fused spine that leaves the patient balanced. |
What
are the goals and expectations of scoliosis surgery?
The goal of surgery for children and adolescents is
to stop the progression of a curve and leave the patient
with a balanced spine in the front and side view plane.
Patients and families are always interested in the amount
a curve was reduced from its preoperative status. I am
frequently asked whether the spine will be straight after
surgery. With the use of new instrumentation techniques,
our ability to straighten the spine is improved. On the
other hand, I always tell the patient that the primary
goal of surgery is to stabilize the curve.
The goals of scoliosis surgery for the adult patient are to stop progression
of the curvature and to improve one's quality of life. Although surgery can significantly
reduce pain in adults with scoliosis, I counsel patients to recognize that their
improvement is viewed as increased function in managing their daily activities
with less pain. |
How
much correction do you expect to achieve?
The spine maintains its flexibility and higher percentages
of correction can be achieved with children, adolescents
and young adults. As was stated in the previous question,
newer instrumentation provides greater corrective forces
than older techniques (Harrington Rods) to straighten the
spine. In these younger patients, corrections up to 60,
70 and 80% are commonly achieved. |
 |
 |
20
year old patient with idiopathic scoliosis underwent
posterior spinal fusion with 85% correction of
the curve. |
|
| As
the patient gets older, the spine becomes less flexible
and a large percentage of correction is more difficult
to achieve. |
 How
long will the incision be, and what can I expect
in terms of scarring?
Any time an incision is made in the skin, a scar is
produced. With careful attention to the technique of closing
the incision the scarring can be minimized and be cosmetically
acceptable. In the standard posterior spinal fusion, the
length of the incision will correlate with the number of
vertebrae that need to be fused. In endoscopic procedures,
multiple one to two inch incisions will be produced at
the point that the camera and instruments are introduced
into the body. Click on the picture to enlarge it. |
Which
vertebrae will be fused in the "average" scoliosis
correction?
The choice of vertebrae that are fused in scoliosis
surgery is determined by the primary curve. Many times
the primary curve has a secondary, flexible curve which
allows the spine to be balanced as the primary curve gets
larger. In most cases only the rigid primary curve needs
to be corrected, and the secondary flexible curve will
decrease by itself without surgery. The determination of
which vertebrae need to be fused takes skill and experience.
Incorrect choices of fusion levels can sometimes lead to
unbalanced spines and further surgery if an unoperated
curve progresses. In rare instances most of the thoracic
and lumbar spine needs to be fused. More often only a minority
of the spine needs to be fused. Correction can be achieved
by fusing three or four vertebrae together in certain types
of curves. |
Do
you normally show the patient the hardware that you
will use in the surgery?
I show patients and their families x-rays of similar
types of operations that the patients are about to undergo.
I do keep a small inventory of metallic implants in my office
for patients to examine, however, I find that most patients
understand the instrumentation by viewing x-rays. |
Can
you see or feel the hardware under the skin?
It is uncommon to be able to see instrumentation under
the skin. Depending on the size of the patient and the
thickness of her skin or fat layer, the instrumentation
may or may not be noticeable to the touch. Even in the
thinnest and youngest patient rarely does instrumentation
need to be removed because it can be felt or seen. |
How
much growth would you expect the fused portion of
my spine to have grown had it been left unfused?
Lost growth potential of fused vertebrae after scoliosis
surgery is dependent on the age of the patient at the time
of surgery. If a patient is extremely young (less than
7 years old), significant loss of height can occur after
spinal fusion. When these young fusion patients are adults,
there will usually be a significant discrepancy between
the size of their torso and the length of their legs. The
actual decrease in their overall height will depend on
what their potential growth could have been based on other
factors such as genetics. In patients with significant
scoliosis, height loss also occurs because it is taken
up in the curvature. If it is possible, surgeons will elect
to delay operations in young patients in an attempt for
them to gain maximum growth potential. Sometimes braces
can be used to hold the curve until this maximum growth
potential is achieved. Unfortunately, if a large curve
is rapidly progressing, it is prudent to surgically control
the curve despite the potential for loss of height. |
What
is a "crankshaft phenomenon," and when does it occur?
Crankshaft phenomenon occurs in a very young patient
who undergoes a posterior spinal fusion for scoliosis. Although
the back of the spine is fused, the front of the spine continues
to grow causing the characteristic twisting of the fusion
mass in crankshaft phenomenon. New more rigid instrumentation
techniques using stronger screws and rods can sometimes overcome
continued of the spine. If this is not possible, the front
and back of the spine may need to be fused by performing
an anterior and posterior spinal fusion. |
Would
instrumentation without a fusion be a better alternative
than a fusion when growth potential is remaining?
The technique of a "growing Rod" is used in very young
patients to maximize growth potential. In this procedure
instrumentation is placed without a fusion. In multiple
intervals, the Rod is lengthened until a time when growth
potential can be maximized. There are clinical investigations
that use partial fusing of growth centers in the spine
(epiphosyodesis) in an attempt to minimally impair growth
potential and induce correction of the curve. At some centers
in very young patients, temporary staples can be placed
across the spine to maximize growth potential. |
What
will I be given for pain after surgery?
Both children and adults are given patient controlled
analgesia for 24-48 hours after surgery. The patient has
control of a button which provides incremental doses of
narcotic medication to effectively control their pain.
After that time period, interval injections of narcotics
and oral pain pills are usually sufficient. The patients
are discharged with a prescription for oral narcotic pain
pills which they may need to take for a few weeks after
surgery. |
How
often will I be awakened and checked by a nurse after
my surgery?
The nurses check on the patients every four to six
hours for the first 24 or 48 hours and then every six to
eight hours after that. The nurses monitor vital signs,
and are looking for any changes in neurologic functions
such as weakness or numbness. |
When
will I be able to get up and walk for the first time
after surgery?
With
rare exception, patients are either walking or getting
out of bed and sitting in a chair within 24 hours after
surgery. |
How
soon will I be able to eat and drink after surgery?
Most
patients can take sips of water or liquid within three
to four hours after surgery. Broth, Jello, and soft foods
are offered, and if they are tolerated, solid food is introduced. |
What
will be done to make my back incision safe after surgery?
A dressing
is kept over the patient's incision for 48 hours after
surgery while the incision seals. Significant protection
is usually unnecessary after the wound has sealed. |
Will
I need physical therapy after surgery?
Adults
are more likely to require physical therapy than children
or adolescents. A prescription for physical therapy after
surgery will depend on the type of surgery performed. If
the instrumentation is holding the spine rigidly, physical
therapy can usually be prescribed within four to six weeks
following surgery. Many surgeons will not institute physical
therapy until three months after surgery or at a time when
the fusion starts to consolidate. |
What
are some types of therapy that I might have to undergo?
Most
children and adolescents do not require any physical therapy.
A careful description of usual post operative activities
will usually suffice with these individuals. In adults,
physical therapy can range from exercises in a swimming
pool to land-based strengthening and cardiovascular instruction. |
Will
I need a special type of mattress on my bed?
No.
The mattress which was comfortable for you before surgery
is usually the one that will be comfortable for you after
surgery. |
How
much experience will the person who is monitoring
my spinal cord function have?
At Cedars-Sinai
Medical Center, the technician who performs neurological
monitoring is extremely experienced, and specializes in
this type of anesthesia. The operating room equipment is
connected by high speed wiring to a central command center.
A specially trained medical doctor monitors the operation
with the technician. Any observed changes in the monitoring
are quickly relayed from the control room to the operating
room for confirmation. |
What
is a "wake up" test and when is it performed?
During
the correction of the spine the spinal cord can become
irritated. A wake-up test is a sensitive technique to detect
any malfunction in the spinal cord during correction of
the spine. It is performed by waking the patient up during
the surgery and asking the patient to move their feet as
a test for spinal cord function. Sedation is provided to
the patient during the wake-up test so that they have no
recollection of being awake during surgery.
Motor evoked potentials are used during surgery. Motor and sensory evoked potentials
are highly sensitive in detecting slight changes in spinal cord function during
surgery. If the patient is able to undergo both motor and sensory evoked potential's
effectively, a wake-up test during surgery is not necessary. If there is any
question about the results of the motor or sensory evoked potentials during surgery,
a wake-up test will be performed. |
I
want my rib hump corrected. How is this done?
The
rib hump is produced by rotation of the chest wall as the
spine curves. In many cases correction of the curvature
of the spine may induce the rotation of the spine to produce
a cosmetically acceptable decrease in the rib hump. If
this cosmetic deformity cannot be adequately controlled
by the instrumentation alone, the ribs are removed and
are used as graft material. This procedure is called they
thoracoplasty and produces excellent cosmetic results. |
When
can I take a shower?
72 hours
after surgery or after the wound seals. |
Do
I have to get my stitches taken out?
The patients return to our office approximately 10
days after surgery for a Nurse Wound Check. Any external
staples or sutchers are removed, the wound is checked for
infection, and rebandaged. Generall, Dr. Pashman doed not
use external sutures. The sutures usually dissolve underneath
the skin. |
When
can I go back to school?
Ideally,
surgeries are done over a school break, either in
late spring or early summer enabling the patient
to return to school in late summer or early fall.
If children meet this surgery schedule, they usually
never miss any school time. |
How
much can I do after surgery?
For
the first year after surgery, activities are decreased.
Normal activities such as walking and traveling are
allowed. If the fusion heels after 12 months all
restrictions are usually lifted. |
How
long will I have to take pain medicine?
Most
young patients remain on pain medicines for two to
four weeks after surgery. Adults may require pain
medicines for a longer period of time, but are discouraged
from taking them beyond three months. |
Do
my rods have to be taken out?
In
my practice it is rare that rods need to be removed.
The most common cause of rod removal is failure of
fusion or disassociation of the rods from the spine.
This is uncommon in young patients. |
Can
I have children if I have had scoliosis surgery?
Yes.
It is advisable that you meet with the anesthesiologist
performing your epidural prior to giving birth. He
may request the latest x-rays of your fusion for
reference. |
Do
I need to eat a special diet and drink extra milk
to help my spine to heal?
No.
In most individuals normal diet will suffice for
healing. |
What
will my activity restrictions be after scoliosis
surgery?
In
most instances, restrictions are lifted after 12
months post-op. Each patient is different and restrictions
may depend on the type of surgery performed and the
age of the patient. |
What
are the differences between an open and an endoscopic
procedure?
Endoscopic
surgery utilizes cameras and instruments which are
manipulated through small portals in multiple places
on the body to correct and stabilize the scoliosis.
The incisions for endoscopic surgery are narrow.
This technique is best applied to single thoracic
curves in young patients with extremely flexible
spines. Failures have occurred because of the technical
difficulties in placing strong enough instrumentation
and applying enough corrective force through small
incisions to induce adequate correction. |
How
big is the actual incision for an endoscopic procedure?
The
multiple small incisions used in endoscopic procedures
measured end to end and then added together would
probably equal the total length of a similar posterior
spinal fusion operation. |
How
long will I have to stay in the hospital after an
endoscopic procedure?
The
length of stay after endoscopic surgery will depend
on the type of surgery performed, the age of the
patient, the technical skill of the surgeon, and
the success of the surgery. The actual length of
stay compared to a similar posterior spinal fusion
or open anterior spinal fusion may differ by a day.
Open anterior and posterior spinal fusion surgeries
in adolescents require a hospital stay for two to
four days after surgery. |
What
are the results of an endoscopic procedure performed
with the CD HORIZON® ECLIPSE® Spinal System?
The
degree of curvature correction and fusion rate for
endoscopic surgery is less than open anterior or
posterior spinal fusion in young patients. In older
patients with larger curves, the results of open
anterior and posterior spinal fusion in terms of
correction and fusion rate are significantly better
than those compared to endoscopic surgery. |
How
will I know if an endoscopic procedure is right for
me?
The
best candidate for an endoscopic surgery is a young
patient with a very flexible spine and a moderate
sized curve (40-65 degrees). Older patients with
less flexible spines and larger curves have inferior
results with endoscopic surgery. |
Is
there a lot of pain after endoscopic surgery?
The
pain after endoscopic surgery can usually be controlled
with similar types of medications that are used in
non-endoscopic spinal correction. |
Can
I shower after the endoscopic surgery?
Yes. |
What
are my limitations after an endoscopic surgery?
The
limitations after endoscopic surgery or similar to
those of non-endoscopic surgery. Because the instrumentation
in endoscopic surgery may not be as rigid, there
is a higher likelihood that those patients who have
endoscopic surgery will need to wear a brace postoperatively. |
When
can I play sports again after I undergo an endoscopic
procedure?
One
year after surgery. |
Will
I need medication if my doctor performs an endoscopic
surgery?
Yes,
it is similar to the anterior/posterior recovery. |
Does
my insurance pay for an endoscopic surgery?
Yes |
Will
an endoscopic procedure improve my rib hump?
Endoscopic
scoliosis correction is generally not as efficacious
in reducing the rib hump as open posterior spinal
fusion. Although ribs can be removed using the scope,
it is technically more difficult and in most instances
not as effective. |
Are
there restrictions for my long-term activity with
an endoscopic procedure?
Long-term
restrictions will be similar to open posterior or
open anterior surgery. |
Can
I have an MRI or CT scan after fusion surgery?
MRI or CT scans are performed on
patients that have had spinal fusion with titanium instrumentation
to rule out re-herniation or to aid the physician in
diagnosing a new problem. Always inform the imaging technician
performing the MRI or CT scan that you have spinal instrumentation. |
Will
my surgery be photographed or video taped?
Occasionally Dr. Pashman
will take interoperative pictures for educational purposes.
The photos or video do not show any identifying features
(such as name or your face). This is covered in your
surgical consent form. If you have a preference about
being photographed, please let Dr. Pashman know when
you sign
the consent form. |
After
spine surgery, do I need antibiotics before getting
my teeth cleaned?
According to a joint study by AAOS (American
Association of Orthopedic Surgeons) and the American
Dental Association. At this time antibiotics are
recommended for two years following an implant
procedure. Notify your dentist when scheduling
an appointment. The dentist will prescribe the
recommended antibiotic if necessary. |
After a
spinal fusion, will the instrumentation in my body set
off the alarm at the airport?
It is recommended, but not mandatory that you advise the TSA officer of an
implanted medical devise. With the current screening system, patients have
not reported setting off the alarm. With the advent of full body scanners,
this may change. |
Should
I donate blood before surgery?
There are pros and cons in donating blood prior to surgery. Generally, Dr.
Pashman does not require patient's to donate blood prior to a surgical procedure. More
information can be found here. |
Related links:
Adult Scoliosis
Adolescent Scoliosis
Adult Scoliosis surgery cases performed by Dr. Pashman
Adolescent Scoliosis surgery cases performed by Dr. Pashman
Scoliosis Braces
Exercises for scoliosis and back pain patients
Books about scoliosis |
