Scoliosis is sideways curvature of spine which mostly occurs during the growth spurt phase just before puberty. Many times, scoliosis can also be caused by other health conditions like muscular dystrophy & cerebral palsy. However, the exact cause of scoliosis is still unknown. Most of the cases of scoliosis are generally mild, but some children are found to develop spine defects which continue to grow & get more severe as they grow. Moreover, severe scoliosis can often be disabling in some cases. Serious spine curvature can reduce the amount of space within chest & thereby make it difficult for lungs to function properly. Children having mild scoliosis are closely monitored, most often with help of x-rays in order to see if curvature is getting worse. However, in 90 percent of cases of scoliosis, no specific treatment is required. Nevertheless, some children will have to wear braces in order to stop curvature from worsening, while many other children might need surgery so as to keep scoliosis from worsening & for straightening irregular spinal structure.
What is Scoliosis?
For maintaining good condition of spine, one needs to have robust & stable core muscles. This includes abs & muscles in backside, from bottom to top. Having a strong core will help restrain further injury & keep patients physically sound. The condition called Scoliosis is not a disease, but it is a term used to report any irregular, sideways curvature of the spine. Typically, a spine is straight when viewed from the back. When scoliosis is detected, the spine can curve in one of following ways.
- A single curve to the left formed like the letter ‘C’
- A single curve to the right formed like a backward letter ‘C’
- Spine having two curves shaped like the letter ‘S’
Orthopedic surgeons are unable to figure out what actually causes the condition of Scoliosis. However, it involves some hereditary factors, as this disorder leans to run in generations of families. Most common types & causes of scoliosis are listed below.
- Congenital Scoliosis – It is caused by an abnormality in patient’s bone which may be present by birth.
- Degenerative Scoliosis – This condition may appear from traumatic bone disintegration, generally caused by an injury, prior surgery of back, or osteoporosis, which is thinning of bones.
- Neuromuscular Scoliosis – Either spine bone fails to form entirely or they fail to separate during fetal development. Generally, patients with this condition develop a long C-shaped curve & have poor muscle strength. This class of scoliosis is often very critical & requires more aggressive treatment.
- Idiopathic Scoliosis – It is the most common type of Scoliosis. Idiopathic Scoliosis has no particular identifiable cause. There exist many theories, but none of them have been found to be conclusive. However, there is strong evidence that this condition of Scoliosis is inherited.
More than 80 percent of the total number of scoliosis cases is found to be idiopathic scoliosis & majority of these cases are among adolescent girls. Most common location of scoliosis among these patients is the thoracic spine region.
- Age – Age is a huge risk factor for scoliosis as signs &symptoms often begin between 9 – 15 years of age.
- Sex – Moreover, being a female also increases the risk of developing scoliosis along with the fact that females have a high risk of worsening spine curvature than males.
- Family History – Family history of scoliosis increases risk of other members developing scoliosis, although several patients developing this problem do not have any family members with scoliosis.
Most common symptom of scoliosis is an abnormal curve of spine which gets worse as the spine twists or rotates in addition to curving side to side. Following is a list of other symptoms of scoliosis which should also be taken into serious consideration.
- Uneven shoulders
- Uneven waist
- One shoulder blade appearing more prominent than the other
- One hip higher than the other
- Shortness of breath along with pain in chest
- Back pain & muscle spasms
Whenever scoliosis is suspected, patients must visit respective orthopedic surgeons for examination. Orthopedic surgeons, however would begin by asking usual questions which include whether there is any family history of scoliosis or if patients have been feeling any weakness, pain or any other medical symptom.
- Physical Examination – This involves taking a look at the curvature of the spine from the front, back & sideways. Patients will be asked to undress from waist up, so as to better see any abnormal curves. Patients will then have to bend over & try to touch their toes. It is because this position can make the display of curvature more obvious. Surgeons will also take a look at the symmetry of the body by seeing whether both shoulders & both hips are at the same height. Any type of changes in skin will also be identified, which can effectively suggest scoliosis due to birth defects. Moreover, doctors may also check the patient’s reflexes, muscle strength & range of motion.
- Checking Progression of Scoliosis – Prospect of growth in patients increase chances of scoliosis getting worse. When this is the case, doctors may measure the patient’s weight & height for comparison during future visits. Other clues to the amount of remaining growth include signs of puberty like presence of breasts or pubic hair & whether the girl patient has begun her menstrual periods. When the doctor makes sure that the patient is having scoliosis, they may either be asked to return for additional examinations after several months so as to see if there are any changes.
- Imaging Tests – Orthopedic surgeons may decide to obtain x-rays of the spine. When x-rays are obtained, doctors can take measurements to determine the size of curve which is present in patients. This will also help surgeons to decide the type of treatment which can prove to be beneficial. Moreover, measurements from future visits will also help them compare so as to see if the curve is getting any worse. It is very important that orthopedic surgeons come to know as to how much of further growth is left with the patients. They may also decide to take additional x-rays of wrist, hand or pelvis which can help them determine as to how much more, will the patient grow. Whenever doctors find any change in functioning of nerves, they may also order other imaging tests for the patient’s back including CT scan or an MRI in order to take a closer look at the nerves & bones of spine.
Non-Surgical Treatment Alternatives for Scoliosis
Treatment options for scoliosis are based upon severity of curves & chances of curves getting worse over time. However, scoliosis treatment is primarily based upon the following two aspects.
- Skeletal growth of patients
- Degree of patient’s spinal curve
There are certain types of scoliosis which have greater chances of getting worse. Therefore, it is the type of scoliosis which also helps orthopedic surgeons to determine proper type of treatment in individual cases. Mainly, there are three main categories of treatment for scoliosis, namely observation, bracing & surgery. Consequently, there are treatments available which do not require surgery, but in certain cases, surgery may be the best treatment option.
Functional scoliosis is generally caused by an abnormality which is present somewhere else in the body. This type of scoliosis is normally treated by addressing the abnormality, like treating a difference in leg length discrepancy. For this purpose, a small wedge is placed within the shoe in order to help even out leg length & thereby prevent the spine from curving. However, there is no direct treatment of spine simply because the spine is normal in these patients.
This type of scoliosis is caused by abnormal development of bones within spine. Neuromuscular scoliosis has the greatest chances of getting worse. Moreover, observation & bracing do not normally work well for patients having this type of scoliosis. Patients having neuromuscular scoliosis will eventually require surgery in order to stop scoliosis curve from getting worse.
Most often, treatment of idiopathic scoliosis is based upon the patient’s age.
In numerous cases of infantile idiopathic scoliosis, patients will generally improve without any kind of treatment. However, x-rays should be obtained & measurements can be compared during future visits in order to determine if the curve is getting any worse. Moreover, bracing is not effective in these cases.
This type of scoliosis has the highest risk of getting worse of all idiopathic scoliosis types. Bracing can however be tried early in these cases if spinal curvature is not very severe. Goal of treatment is to prevent curve from aggravating until the time when patients stop growing. Since spinal curving starts early among these patients, they still have a long time to grow & therefore there is higher chance that they require more aggressive forms of treatment including surgery.
This is one of the most common forms of scoliosis. It can also be observed & effectively followed with routine x-rays & measurements in case curvature is small when first diagnosed. In case curvature or Cobb angle stays below 20 – 25 degrees, no other treatment is required. Cobb angle or method is a way to measure degree of curvature. Adolescent idiopathic scoliosis patient must also return to consult the doctor every 3 – 4 months in order to check if there is any degeneration of spinal curve. Additionally, x-rays must also be repeated every year in order to gather new measurements & compare them for progression of the spinal curve. Moreover, if the curvature is between 25 – 40 degrees & the patients are still in growing phase, then bracing may also be recommended. Surgery is however invariably recommended if the curvature is found to be greater than 40 degrees.
Typically, scoliosis is not associated with back pain. But painful symptoms can be effectively lessened with exercises, massage, physical therapy & yoga (refrain from twisting pressure on spine) in some scoliosis patients with back pain. These activities will also help strengthen back muscles. Medical treatments are however limited to pain relievers like NSAIDs or non-steroidal anti-inflammatory drugs & anti-inflammatory injections. But these treatments do not offer any cure for scoliosis & will not in any way correct abnormal spinal curvature.
There are many different types of braces available for scoliosis patients. Some of these are required to be worn 24 hours every day & are supposed to be removed only for showering or bathing. Ability of a brace to work depends upon how sincerely the patient follows instructions provided by doctors regarding wearing braces. However, braces are not designed to correct spinal curvature. They are generally meant to slow or stop curvature from getting worse along with proper back brace management treatment. Braces are generally discontinued after the patient’s bones have stopped growing. This typically occurs in the following conditions.
- Usually about 2 years after the girl child has begun to menstruate
- When the patient is having no further changes in height
Following the given guidelines will help patients ensure a successful outcome post-surgery.
- Avoid Smoking – When the patient is a smoker, surgeons will ask to quit smoking prior to undergoing spine surgery. Smokers are more prone to low back & neck problems.
- Weight Reduction – Excessive weight creates mechanical stress on the patient’s back & can make spine surgery more difficult. Weight reduction plan, as suggested by the surgeon, should be followed in advance of surgery.
- Health Problems – To check whether patients have any major health issues, surgeons will ask them to undergo a complete physical test prior to undergoing surgery for scoliosis.
Patients have the right to understand the complete procedure of scoliosis surgery before deciding to undergo the same. Patients may ask the following relevant questions to orthopedic surgeons during initial consultation.
- What is scoliosis?
- What factors are responsible for my scoliosis?
- Can you explain my diagnosis results?
- Does my scoliosis need to be treated?
- What are the available treatments options for scoliosis?
- What is bracing?
- Do I require any surgery for scoliosis?
- Will I be able to exercise after scoliosis surgery?
- Where can I get some additional information about scoliosis disorder?
- Do you have any prior experience in performing surgery? How many years?
- What happens if spinal rod breaks after surgery?
- Will I require more than one surgery for treating scoliosis?
- What are the permanent side-effects following surgery?
- Is there any risk of back pain in future following the recommended surgery?
- Will this surgery rectify the hump on my back?
- Will I be able to move my back or bend over after surgery?
In case spinal curvature stays below 40 degrees by the time patient has finished with growing, it is most likely not to get worse later in life. However, in cases where curvature is greater than 40 degrees, it is likely to continue getting worse by 1 – 2 degrees each year, for the rest of the patient’s life as long-term effect of scoliosis. If it is not prevented from deteriorating, patients would eventually be at risk for lung or heart problems. Typically, scoliosis progresses with time. Therefore, orthopedic surgeons may suggest scoliosis surgery in order to reduce severity of spinal curvature & prevent it from worsening.
- Spinal Fusion – Goal of surgery for scoliosis is to correct & stabilize spinal curvature, reduce pain & restore a more normal appearance & curvature to the spinal column. Surgery for scoliosis generally involves correcting the spinal curvature to as close to normal as possible & performing spinal fusion in order to hold the correction in place.
- Bone Graft – This is possibly achieved with a combination of rods, hooks & screws which are attached to bones of spine in order to hold them in place. For this purpose, surgeons place bone graft around bones which are to be fused so as to help them grow together & fill up to become solid. This process will also prevent curvature from worsening at this junction of spine. However, in most scoliosis surgery cases, screws & rods will remain within spine & will not be removed anytime. There are several different techniques which are available to surgeons for performing fusion surgery for scoliosis.
- Metallic Rods – In case scoliosis is rapidly progressing at a young age, surgeons can also install a metallic rod which can adjust in length as the child is growing. This piece of adjustable rod is attached to the top & bottom sections of spinal curvature & is usually lengthened every 6 months as required. Entire procedure can also be performed through a single incision at the back of spine or combined with another incision along the side or front. However, this decision is entirely based upon the severity & location of the spinal curve.
Recovery from spine surgery & scar formation varies from one patient to another. Antibiotics will be administered from the beginning of the surgical procedure to around 48 hours post-surgery in order to avoid risk of infections at the surgical site. Orthopedic surgeons normally use medications in order to control patient’s initial pain following surgery. Patients are most likely to be out of bed in a wheelchair on the first day following surgery & will work with physical therapists who will assist them in walking. It is quite important to improve muscle strength as patients continue to recover. Physical therapists will also help patients to perform exercises for re-energizing muscles & overcoming back pain. Complete healing can take up to 6 months of time depending upon the patient’s routine & will power.
Like it is with all types of surgeries, there are risks & complications involved with scoliosis surgery as well. However, amount of risk partially depends upon the patient’s age, degree of spinal curvature, cause of curve & the amount of correction attempted by the surgeon. In most cases of scoliosis surgery, surgeons usually use a technique known as neuro-monitoring during the treatment procedure. This technique allows surgeons to monitor function of nerves & spinal cord during surgery. Whenever patients are placed at increased risk of damage with this technique, orthopedic surgeons are alerted & they can subsequently adjust the procedure so as to reduce those risks. Small risk of infection which is involved with all types of surgical interventions is effectively decreased with use of antibiotics, but then it can still occur in some cases. Other potential risks associated with scoliosis surgery include the following.
- Injury to nerves or blood vessels
- Continued progression of curvature following surgery
- Broken screws or rods
- Need for additional surgery
School screening programs which are regularly conducted have helped in identifying many cases of scoliosis in early stages. Having identified scoliosis early allows patients to be either treated with observation or bracing in order to avoid the need for surgery in many cases. Most patients with scoliosis go on to live a fully productive & normal life. Female patients with scoliosis are perfectly able to get pregnant & have children without any increased risk for complications. However, they must take care as they may be at increased risk for additional lower back pain during pregnancy. Generally, prognosis worsens as the degree of spinal curvature increases. Life expectancy of scoliosis patients has been reported to be reduced by about 14 years in some cases. This especially includes those patients who were having more severe Cobb angle which was left untreated. However, not all specialists agree with this controversial finding. There are many other clinicians who either choose to avoid any controversy & say nothing or as some of them suggest that most scoliosis patients would live a near-normal life span.
Medical Tourism for Best Treatment of Scoliosis
Over the past few decades, many countries have managed to be some of the most popular global medical tourism destinations providing a wide spectrum of healthcare solutions to international patients. While surgical procedures including orthopedic treatments across the world were getting expensive by the day, healthcare industry among these select countries kept growing at a fast pace so as to fulfill the growing demand for affordable medical treatments & procedures. Vast pool of surgeons in these countries comprise of globally reputed surgeons, many of whom have initially trained & experienced in advanced western countries like the UK, Canada & United States before returning to practice in their homeland. Numerous hospitals in an extensive network of facilities are internationally accredited & committed to global standards. Another strategic advantage for foreign patients is that a large number of skilled nurses & professional staff managing healthcare institutions in these countries are able to speak English in order to make international guests feel comfortable.
Surgery for Scoliosis with Travcure Medical Tourism
Travcure Medical Tourism is one of the best globally reputed healthcare service facilitator. Associated with top doctors & a wide network of accredited hospital facilities in countries like Turkey, Germany, United Arab Emirates (Dubai), South Korea (Seoul) & India, Travcure offers healthcare packages for a variety of treatment procedures including orthopedic solutions like surgery for scoliosis to international patients. Services offered by Travcure are very competitive & reasonably priced, keeping the welfare of patients in mind. Seamless services offered by Travcure experts begin with the first telephonic conversation & go on to identifying the best orthopedic surgeons & ideal hospitals for treatments like for scoliosis. Other essential services offered by Travcure include assisting patients & their accomplice obtain medical visas, warm reception at airport on arrival for treatment, convenient local travel, comfortable accommodation options, scheduling appointments with doctors & surgeons for diagnosis & treatments without any waiting period, choice of an exotic recuperative holidays at reasonable costs, follow-up evaluation checks at hospitals & an affectionate farewell sendoff when patients head back to home after successful outcomes.
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