Treatment Options for Scoliosis and Other Spinal Deformities
Scoliosis and Deformity
The spine is made up of five regions: cervical, thoracic, lumbar, sacrum, and coccyx. In order to maintain an upright posture, the body balances the head over the center of the pelvis in both the coronal (front) and the sagittal (side) planes. In the coronal plane, the spine should be straight. In the sagittal plane, the spine should have a S-curve, made up of lordosis (sway back) in the cervical spine, kyphosis (round back) in the thoracic spine, and lordosis (sway back) in the lumbar spine. Spinal deformities, such as scoliosis and kyphosis, indicate a change in the body’s normal alignment.
Scoliosis refers to a curvature of the spine in the coronal (front) plane. Idiopathic scoliosis typically develops during adolescence and involves both a curvature of the spine as well as a rotation of the vertebral bodies. Children are often treated surgically for scoliosis once the curvature becomes greater than 40-50 degrees or is progressing quickly. Patients who were not treated in adolescence may develop symptoms associated with arthritic changes of the idiopathic scoliosis in adulthood. Degenerative scoliosis generally develops during adulthood due to arthritic changes and does not typically involve significant rotation of the vertebral bodies. Neuromuscular scoliosis refers to a curvature of the spine due to inadequate muscular support of the spine. It is associated with neuromuscular conditions such as cerebral palsy, muscular dystrophy, and Parkinson’s disease.
Symptoms of scoliosis may include: back pain, leg pain, prominence of the ribs or scapula on one side, inability to stand up straight, shift of the torso to one side, and/or loss of height. Evaluation of scoliosis includes a clinical exam, standing scoliosis x-rays, MRI scan, and possibly a CT scan.
Treatment Options for Scoliosis
The ultimate goal of surgical treatment for scoliosis is to restore and maintain a natural, upright spinal alignment, with the head balanced over the pelvis. Surgical treatment of scoliosis has greatly evolved over the past 50 years. Traditional surgical options involve large exposures, with stripping of the muscles and ligaments and sustained retraction of the tissues, in order to access the spine. These procedures are often associated with increased blood loss, longer operative times, and postoperative medical complications. With the development of new technologies, minimally invasive options became available in treating scoliosis.
Currently, Dr. Anand treats scoliosis with a combination of minimally invasive techniques. Adolescent and adult idiopathic scoliosis is often treated with a posterior pedicle screw-rod system in order to derotate the vertebral bodies and straighten the curvature of the spine. The system is implanted using a series of tubes to dilate through the muscle instead of stripping the muscle from the bone. Degenerative scoliosis and, sometimes, adult idiopathic scoliosis require a circumferential approach, placing implants into the disc spaces and posteriorly. Access to the disc spaces is achieved through a dilating tube system on the side of the abdomen (DLIF/XLIF) or through the front of the abdomen (ALIF). A pedicle screw-rod system is used posteriorly through a minimally invasive approach to derotate and straighten the spine and stabilize the alignment.
Kyphosis refers to a curvature of the spine in the sagittal (side) plane. Scheuermann’s kyphosis is an idiopathic curvature of the spine that usually evolves during adolescence, with wedging of sequential vertebral bodies. Proximal junctional kyphosis is an increased curvature due to the collapse of the disc spaces just above a prior spinal fusion. Kyphosis can also develop due to arthritic changes in the spine, fractures, trauma, tumors, or neuromuscular disorders.
Symptoms of kyphosis may include: back pain, leg pain, inability to stand up straight, poor posture, hunchback, leaning forward while standing or walking, and/or loss of height. Evaluation of kyphosis includes a clinical exam, standing scoliosis x-rays, MRI scan, and possibly a CT scan.
Surgical treatment options for kyphosis are similar to options for scoliosis. The goal for surgery is to restore and maintain a natural, upright spinal alignment, with the head balanced over the pelvis. Options may include a posterior only approach versus a circumferential (anterior and posterior) approach. For extreme kyphosis deformities, Dr. Anand may consider a traditional, open approach to the spine that allows him to perform an osteotomy to better correct the alignment of the spine.
Dr. Anand also treats Flat Back Syndrome, Post Laminectomy Syndrome, and Pseudarthrosis with minimally invasive techniques.