Scoliosis

What is scoliosis?

The shape of the spine in the human being, seen in profile, is not straight, it has four natural curvatures, very important for distributing the effort required by movement in daily activity: cervical, thoracic, lumbar and sacral curve.

• Scoliosis is one of the most complex pathologies of the spine. This is a lateral curvature of the spine that affects the morphology of the trunk, when the spine seen from the front presents an “S”-shaped lateral curvature.

This condition can be suffered at any age and its cause can be a neurological or neuromuscular disease, or a congenital malformation. In a high number of cases, it has no known cause.

What are your symptoms?

It can have an early onset and appear before the age of 10 or in adulthood. But it is in adolescence, during the growth period, when it affects approximately 3% of the population. In 0.3% of cases it presents with curves that may require surgical treatment. In all age groups, it mainly affects the female sex.

The impact of scoliosis on quality of life is significant and varies across life stages. Children do not have pain but due to the development of the trunk, they may have complications in the cardio-respiratory system.

Adolescents suffer the impact of self-perception, since their body image is distorted as a result of the deviation. Symptoms are uneven shoulders and/or waist; one shoulder blade more prominent than the other or one side of the waist higher. If the curvature caused by scoliosis worsens, the spine will also rotate or twist, in addition to hunching from side to side.

In adults, scoliosis may be accompanied by lower back pain and deterioration in body shape, weakness, or pain or numbness radiating to one of the legs.

In the young adult, a gibbosity (lump on the back) may appear and in the older adult there is usually an anterior imbalance of the trunk. As people get older, they tend to lean forward and sometimes also to the side.

Types of scoliosis

Pediatric and adolescent scoliosis

• Congenital (present at birth)

Occurs during fetal development. Often caused by vertebrae that did not form normally; due to absence of vertebrae; by partially formed vertebrae; or due to lack of separation of the vertebrae.

• Neuromuscular

Associated with many neurological conditions. It happens especially in those children who do not walk, and who suffer, for example, cerebral palsy, spina bifida; muscular dystrophy; paralytic conditions; spinal cord tumors; or neurofibromatosis, among others.

• Idiopathic

In 80% of cases of scoliosis, its origin is unknown. There are 3 types of idiopathic scoliosis:

• • Children’s

It appears from birth to 3 years of age. The curve of the vertebrae typically presents to the left and is most commonly seen in children. The curve usually disappears as the child grows.

• • Juvenile

It arises in children between 3 and 10 years old.

• • Addolescent

It occurs in children between 10 and 18 years old. It is the most common and is more common in girls.

Adult scoliosis

Adult spinal deformity can have three causes:

• • Untreated pediatric or adolescent scoliosis in childhood
• • Degenerative scoliosis as a consequence of the aging process, due to wear and tear of the discs and joints of the spine.
  This is the most common cause of adult scoliosis, mainly due to the population’s longer life expectancy. We already know that in Western countries almost 30 percent of the population over 65 years of age has a somewhat deformed spine to a lesser or greater degree.
• • Deformity resulting from previous failed spinal surgery Failure to fix the spine in the correct alignment can produce a deformity.

What is the treatment of scoliosis?

When the vertebral deformity is significant in adolescents, with curvatures greater than 45 degrees, and when it is the cause of other health complications, scoliosis surgery is the indicated treatment. In children under 10 years of age, the challenge is how to correct and avoid spinal deviation while allowing growth and proper development of the lungs and respiratory system. Due to the complexity of this type of intervention, the strategic approach to the operation is key, because although it is usually a grateful surgery, the risk of complications is not low, especially in adults and small children.

In adulthood, scoliosis is operated on when it is associated with pain that is not controllable with conservative treatment or when it shows progressive worsening over time.

Scoliosis surgery in both pediatric and adult age has been shown to be effective in improving the quality of life of these patients.

The ultimate goal is to ensure the best possible mobility and function for the back. This is one of the main indicators of the success of the intervention.

How is scoliosis diagnosed?

Generally, radiological studies will be carried out directed by the surgeon himself, in order to calibrate the optimal point of correction of the deviation that will be addressed during the operation. Also occasionally, in severe or more complex scoliosis, it is necessary to make 3D printed models of the spine. This allows us to visualize the specific problem posed by a given patient, and to study the best approach before and during the intervention.

But the decisive thing is that an operation of this magnitude is undertaken by a multidisciplinary specialist team, with exclusive dedication to the spine, in which the participation of preoperative optimization is very important.

What is the recovery from scoliosis surgery?

A good surgery will result in improved physical appearance in the adolescent and pain relief in the adult; and the repair of the alignment and morphology of the trunk, avoiding other complications in all age groups, and especially in children. Although it depends on the severity of the cases, patients return home soon after scoliosis surgery and within a few weeks they return to normal. After 6 months, the operated back is already consolidated.

Why trust Dr. Ferran Pellisé ?

• Because he specializes in scoliosis surgery, deformities and highly complex spine surgery.
• Because he has more than 25 years of experience.
• Because he performs more than 70 scoliosis surgeries a year.
• Because he treats patients of all ages: babies, children, adolescents and adults.
• He is the secretary of the Scoliosi Research Society (SRS).