What is scoliosis?

What exactly is scoliosis? The word “scoliosis” comes from the Greek word skolios, meaning “twisted”. It’s used as the medical name for an abnormally curved or twisted spine.

Having a slight degree of scoliosis doesn’t necessarily constitute a health problem; in fact, it’s estimated that almost 3% of the population have minor scoliosis, a curve of less than 10 degrees, and it doesn’t affect their health at all. However, if the curvature is greater than that, treatment is recommended because otherwise it can lead to long term health problems.

Causes and symptoms of scoliosis

CAUSES

Curvature of the spine can be due to a variety of factors: severe injury, neurological disease, previous back surgery... But for more than 70% of people with scoliosis, the origin of the problem cannot be determined. These cases are referred to as “idiopathic scoliosis”. “Idiopathic” is the medical term used for diseases or disorders for which the cause is unknown. It comes from the Greek words: idios (one’s own self), and pathos (suffering). 

SYMPTOMS

The symptoms of scoliosis depend on both how much the spine is curved and also how long the person has had it. In the case of children with scoliosis, most of them do not notice any pain, and in adults, it’s usually not until after the age of 30 that the scoliosis becomes worse and begins to cause problems, including:

  • Pain after sitting or standing for extended periods of time. This gets worse over time due to degeneration of the spinal column.
  • If left untreated, over time the scoliosis can lead to more serious complications, because the position of the torso can affect the lungs and heart.

How is scoliosis classified?

In addition to classifying it by cause (trauma, idiopathic, etc.), scoliosis is commonly broken down into other classes.
 

Whether the scoliosis is permanent or not:

Structural or “true” scoliosis

Said of scoliosis where a section of the spinal column is twisted or rotated in a way that is pathological or permanent.

Functional or compensatory scoliosis

Said of scoliosis in which a section of vertebrae compensates or balances the curvature caused by the truly deformed vertebrae. 

Where the curvature is located:

Thoracic scoliosis

The peak of the curve is in the thoracic section of the spinal column.

Lumbar scoliosis

The peak of the curve is in the lumbar spine. 

Thoracolumbar scoliosis

The peak of the curve is located at the junction of the mid back (lower thoracic) and low back (upper lumbar).

The curve can be in either direction, so scoliosis is also classified as left or right convex scoliosis, depending on which direction the curve turns.

Idiopathic scoliosis:

When a patient has a curvature of the spine of more than 10 degrees, in either the thoracic or lumbar sections of the spinal column, and no cause can be determined, it is referred to as idiopathic scoliosis.

According to patient age, scoliosis is classified as follows:

Infantile scoliosis

0-3 years

Juvenile scoliosis

4-11 years

Adolescent scoliosis

11-18 years

Adult scoliosis

Persons older than 18

Scoliosis in children and adolescents

Many times, scoliosis arises during growth spurts associated with childhood and adolescence. When a child’s spine has a curvature of more than 20 degrees, it is noticeable early on, so in preadolescence, scoliosis can often be detected in a misalignment of hips or shoulders, as well as other deformities of the trunk. 

The appropriate treatment options for scoliosis in children depend especially on the degree of curvature. Nonsurgical treatments can be effective in some cases. When the spinal curvature is less than 20 degrees, the usual medical advice is for postural exercises to reeducate the body and strengthen the supporting musculature to keep the curve from increasing as the child grows. 

When the curvature is between 20 to 40 degrees, in addition to those exercises, the doctor may recommend use of a brace, either to wear at night or 24 hours a day. In cases where the degree of curvature is greater than 40-45 degrees, causing serious deformity or pain, corrective surgery is recommended. 

Scoliosis in adults

Most people with scoliosis don’t even notice it until later on in life when the degree of curvature can increase and other medical conditions such as osteoarthritis appear. 

In adults with scoliosis, we can differentiate between two types of patients: those with pre-existing idiopathic scoliosis and those with new onset scoliosis. 

In some cases, adults have pre-existing scoliosis that didn’t cause them problems when they were young, but as they mature, the degeneration of the spinal discs and facet joints causes the scoliosis to worsen resulting in spinal imbalance. Often, the curvature becomes more pronounced and it can affect people with other problems, such as sciatica in the legs, caused by a herniated disc, narrowing of the spinal canal or pressure on the nerves. Sometimes the deformity is so severe that it affects the patient’s ability to lead a normal daily life. 

In other adult patients, the degeneration of the spine that comes with age leads to a secondary or “new onset” scoliosis. This usually shows up in the thoracic or lumbar segments when wear on the veterbral discs leads to a misalignment of the spinal column. In these cases, the treatment is aimed at the specific portion of the spine causing pain, and a surgical solution is only recommended when the scoliosis causes a truly disabling deformity. 

How is scoliosis diagnosed?

Since many cases of scoliosis appear during growth spurts, it is often diagnosed when children are between the ages of 10 to 12. Then the child’s parents notice the spinal curvature and decided to take the child to the doctor. 

To make a diagnosis requires an overall physical exam by a medical professional. At the Instituto Clavel, this exam includes a low dose bi-planar X-ray using the new EOS technology, which provides a scoliogram with which the doctor can make a very precise assessment of the scoliosis. 

Treatment of scoliosis

Depending on the severity of the scoliosis, treatment options can range from conservative measures to surgery. In mild cases, the most common choice is physical therapy, with exercises to strengthen the muscles of the patient’s spinal column. This type of conservative treatment has proven to be effective for mild cases of scoliosis. 

GO TO PHYSIOTHERAPY AND REHABILITATION

When the severity of the scoliosis is intermediate, the doctor may recommend use of an orthopedic brace in addition to physiotherapy.  During the childhood growing years, physicians recommend wearing an orthopedic brace for 23 hours a day to help correct the scoliosis. Understandably, this is very uncomfortable for the patient, but as time goes by, the use of the brace can be reduced.

However, when the deviation of the spinal column is severe and disabling, surgery is needed to correct it. At the Instituto Clavel we do treat infantile, juvenile and adult scoliosis.

What happens in scoliosis surgery?

Scoliosis surgery consists of correcting the affected segment by realigning and fusing the necessary vertebrae. This is done by precise placement of pedicle screws, which are then connected to metal rods of different alloys, to achieve the proper alignment of the spinal column.   

Nowadays, with exhaustive planning, we can use much less invasive techniques to improve the results of the surgery.

1. WE BEGIN BY MAKING A THOROUGH SURGICAL PLAN

To do this, we are aided by the low dose bi-planar X-ray imaging equipment called EOS, which allows us to make a precise study of all the angles and shapes of the scoliosis, and in addition, the 3D reconstruction helps us simulate the result of the surgery.

2. INTRA-OPERATIVE GUIDED NAVIGATION

To ensure the correct placement of the screws, at the Instituto Clavel we use the real-time intra-operative imaging device O-Arm 2, which permits precise placement of the pedicle screws in curves rotated at different angles. Thanks to this, we are able to perform the complex maneuvers needed to align the spinal column without harming it, and the resulting correction is better.

In addition, we use the Mazor X robot technology to improve the planning of the surgery in order to optimize the location of the screw placement even more.

3. CUTTING TECHNOLOGY

In order to align the spinal column, the surgeon makes small incisions in the vertebrae. These cuts are called osteotomies. Thanks to modern technology, these small cuts are actually made by ultrasound, which means the cuts cause no bleeding.

4. BLOOD SALVAGING 

We use intra-operative blood salvaging (IOS) making a reserve of the patient’s own blood during the surgery, reducing the need for donor transfusions post-surgery. 

5. MONITORING

A neurophysiologist is present throughout the surgery, to safeguard the integrity of the spinal cord and other neural pathways through continuous intra-operative neurophysiological monitoring.

6. SURGERY BY STAGES

At the Instituto Clavel we also practice surgery by stages. That is to say, we may perform a minimally invasive abdominal or lateral approach surgery to help correct the scoliosis prior to performing the posterior approach surgery for placement of screws. We have found that dividing the surgery in separate stages over different days helps minimize the patient’s suffering and greatly facilitates postoperative recovery.

7. MULTIDISCIPLINARY MEDICAL TEAM

Scoliosis surgery requires a highly specialized, multidisciplinary medical team. At the Instituto Clavel, our team for treating scoliosis includes nurses, physiotherapists, traumatologists, neurosurgeons, and doctors specialized in pain management. 

Recovery following scoliosis surgery

Physical rehabilitation plays a key role in the recovery from this kind of surgery. At the Instituto Clavel, we work with FisioSpine, a center specializing in rehabilitation of complex back problems, including scoliosis. The staff at FisioSpine offers treatment and guidance using specific exercises appropriate to each stage of recovery. 

Who are the doctors who treat scoliosis at the Instituto Clavel?

Dr. Charosky
Dr. Català
Dr. Ríos
Dr. Vázquez
Dr. Clavel
 

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