Scoliosis in adults

Scoliosis in adults, like scoliosis that occurs at other ages, is a curvature or deviation of the spine of more than 10 degrees in three dimensions: the frontal, sagittal and transversal planes. However, unlike scoliosis that occurs earlier, the treatment for scoliosis in adults is different, because the patient's spine is already fully developed.

When an adult suffers from scoliosis, it is one of two types. It can be scoliosis that already existed during adolescence but was left untreated and the curvature has increased because of degeneration of the spinal discs and facet joints, or, it can be new onset scoliosis, when an adult who previously had a straight spine, now has a curvature of the spine due to wear on the discs or other factors. In cases of new onset scoliosis, it usually occurs in the thoracic and lumbar spine.

Causes of scoliosis in adults

There are several factors that can lead to the development of a deviation of the spine:

   INJURY (ACCIDENT, BLOW, FALL, ETC.)
    NEUROLOGICAL DISEASE.
    CONGENITAL MALFORMATION OF THE BONES OF THE SPINE.
    DEGENERATION OF THE SPINE.
    OSTEOARTHRITIS. 
    OSTEOARTHRITIS. 

However, in more than 70% of the cases, the cause is unknown, so it is referred to as adult idiopathic scoliosis. This is often the case when an adult patient comes to see us with scoliosis that they have had since childhood or adolescence that was not previously treated.

In those adults who suffer from new onset scoliosis, it is usually caused by a combination of factors such as the aging of the spine, the degeneration of the intervertebral discs and/or osteoarthritis.

Symptoms of scoliosis in adults: chronic pain and improper balance

The main symptom of scoliosis in adults is chronic pain, either in the back or the legs. Leg pain occurs because adult scoliosis can cause compression in the nerves of the lumbar canal area. This pain is accentuated when the patient remains seated or standing for a long time.

Another symptom is feeling off-balance, caused by the hunch or hump in the back, which can also affect the patient on an aesthetic level.

Although it is not as common, other, more serious symptoms may appear due to the position of the torso, and how that affects the heart and lungs as they are housed in the rib cage.

How is scoliosis diagnosed
at Instituto Clavel?

At Instituto Clavel, we make our diagnosis based on a thorough, overall examination. Tests include a low dose bi-planar scoliogram X-ray using the new EOSedge technology. With this scanner, we obtain a high-quality image of the complete spine of the patient that allows us accurately determine the magnitude of the scoliosis. This test is usually supplemented with an MRI of the entire spine.

If the patient requires surgery, the preceding will also be complemented with a CT scan of the spine. In addition, in adults, a bone density test is also usually done to check the quality of the bone.

 

Treatment options for scoliosis in adults

In adult scoliosis, the first step is always to begin with conservative treatments focused on relieving back pain, with analgesics or infiltrations in the affected area of the spine. Keep in mind that this step only reduces the symptoms to improve the patient's quality of life, but does not prevent the condition from progressing.

If the effects of the patient’s scoliosis are disabling, and conservative treatments do not provide enough pain relief to allow them an acceptable quality of life, then we can consider correcting the spine by surgery. It is important to bear in mind that this decision is always made on a completely case-by-case basis, because it is necessary to take into account the patient's previous health condition, their age and other determining factors, to ensure that surgery is the right choice.

What is scoliosis surgery like?

Scoliosis is a deviation of the spine, so the goal of the surgery is to straighten the curved segment by realigning and fusing the vertebrae as needed. The technique used involves instrumentation, that is, placing transpedicular screws that are connected with metal rods to straighten the spine.

Instituto Clavel is unique in Spain in this type of surgery, because thanks to the planning of the surgery with the EOSedge scanner and Keops software, we can foresee the result of the correction and design the surgical rods to custom fit the patient's spine using the Kheiron system hardware. We are the only center in Spain that currently does this. The standard method until now was for the surgeon to bend the rods in the operating room based on their experience, so having the rods already molded to fit the patient allows us to provide personalized medicine with better results.

Scoliosis surgery: advances thanks to surgical planning and customized rods | Instituto Clavel

1. Thorough planning of the surgery

We do this using the technology of the EOSedge scanner, as we mentioned above. This device makes it possible to perform an accurate analysis of all the angles and shapes of the scoliosis. In addition, with the Keops software we are able to make a 3D reconstruction that simulates the final result after surgery, and customize the surgical rods for the patient.

2. Guided intraoperative navigation

To ensure an exact placement of the screws, at Instituto Clavel, we have intraoperative navigation guided by O-Arm 2 or Loop X, which allows a precise placement of the pedicle screws in rotated curves at various angles. Thanks to this, we can perform the complex maneuvers needed to align the spinal column without stressing it, and the result of the correction is better.

We also have the Mazor X robotic technology that significantly increases the precision and safety of the surgery.

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3. Cutting technology

In order to align the spine, small cuts called osteotomies are made in the vertebral bones. Thanks to the ultrasound bone cutting technology we use, the cuts can be made with minimal blood loss.

4. Blood salvaging

We have intraoperative blood salvaging equipment that allows blood lost during surgery to continuously returned to the patient's bloodstream, decreasing the need for blood transfusions after surgery.

5. Monitoring the patient's condition throughout the surgery

A neurophysiologist is always present during the surgery, using an intraoperative neurophysiological monitoring system to oversee the safety of the nerves and spinal cord throughout surgery.

6. Surgical staging to minimize trauma

At Instituto Clavel, we carry out the surgeries in stages. That is, we first perform correction of the curvature using a minimally invasive anterior or lateral approach, and following that, use the posterior approach for the transpedicular screws. By dividing the surgery into different days, we minimize trauma to the patient and help speed up postoperative recovery.

7. Highly qualified multidisciplinary team

These surgeries are complex and highly specialized, so a multidisciplinary professional team is needed. That’s why, at Instituto Clavel, our scoliosis team includes almost everyone in the medical team: nurses, physical therapists, traumatologists, surgeons, neurosurgeons, neurophysiologists, anesthesiologists, the intensive care team and the doctors of the pain clinic.

Recovery after scoliosis surgery

Rehabilitation is very important for patients recovering from scoliosis surgery, and at Instituto Clavel, we have a rehabilitation team formed by physical therapists specialized in the spine. This team will provide support to the patient at every stage of their recovery, with manual and active physical therapy, as well as recommendations for correct posture habits to use every day.

Which doctors at Instituto Clavel treat adult scoliosis?

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



 

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