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Scoliosis (cont.)

How Often Is Follow-up Needed After Treatment of Scoliosis?

If your child is referred by the school for a scoliosis evaluation, you should make an appointment to see your primary-care provider or pediatrician within the next month or so. Physicians in these specialties can then evaluate your child and decide whether you child should be monitored with a repeat examination or referred to a pediatric spine specialist for further evaluation. If your child requires bracing, he/she will be followed by a spine surgeon. Follow-up examinations and X-rays are generally obtained every three to six months to monitor the child for worsening of the curves. Children who require bracing will be seen regularly by an orthotist (brace maker) for adjustments. The timetable for these adjustments varies depending on the child's rate of growth. During the periods of rapid growth during puberty, these adjustments will be at more frequent intervals and may require new construction of all or part of the brace. If your child is treated with a brace, you should follow the instructions provided by your doctor for its use. Follow-up intervals after surgery are determined by the type and extent of the surgery, and the surgeon will give you instructions regarding follow-up evaluations.

Are There Ways to Prevent Scoliosis?

Scoliosis is not preventable. At this time, we do not understand what causes the condition in the majority of children. Massage, yoga, chiropractic treatments, osteopathic adjustments, and exercises without bracing will not prevent scoliosis, correct the curvature, or slow the progress of the scoliosis. Vitamins, calcium supplements, stretching, body wraps, muscle stimulators, and other home remedies will not prevent or cure idiopathic scoliosis.

What Types of Surgery Treat Scoliosis?

Surgical treatment of idiopathic scoliosis is indicated for curves that are greater than 50°, progressing rapidly despite bracing, or which are expected to progress beyond the end of bone growth; decreased heart or lung function due to loss of chest space (capacity); compression of the abdominal (belly) organs due to loss of abdominal space; severe cosmetic deformity; loss of balanced position of the head and/or body over the pelvis; and/or escalating back pain. The goals of surgery are to release the soft tissues holding the bones of the spine in the incorrect position, restore the position of the spinal bones to as close to normal alignment as possible, maintain the corrected position by stabilizing the spine with a combination of metal plates, screws, hooks, wires, and/or rods, and bone grafting to fuse the bones of spine together permanently. Corrective surgery may be done from the front (anterior approach) of the spine, the back (posterior approach) of the spine, or a combined procedure. The majority of scoliosis surgeries are done from the back of the spine. If both anterior and posterior approaches are necessary, they may be done on the same day or two different days with a recovery period of a few days in between, depending on the extent of the individual surgical procedures required.

A newer technique (called thoracoscopy) for approaching the upper (thoracic) spine from the front through the chest uses a fiberoptic scope and special instruments to release and fuse the spine. This may be suitable for some patients with a curvature involving the upper back (thoracic spine) and avoids a large incision (called a thoracotomy) into the chest. The pediatric spine surgeon will determine if this is an option for your child. If a thoracotomy is necessary, the spine surgeon may work with a chest (thoracic) surgeon to open and close the chest. If a surgical approach through the chest is carried out, a chest tube to reinflate the lung(s) will be used. A combination of plates and screws into the bones (if surgery is necessary from the front of the spine, or screws into the spinal bones attached to rods near the spine if the spine is approached from the back) are used to stabilize the spine while waiting for the bones of the spine to fuse.

Bone graft obtained for the back of the patient's (called autologous bone) pelvis (iliac crest bone graft) and/or various types of human donor bone grafts (called allograft bone) and synthetic bone grafts are placed around the bones of the spine to encourage the spine to fuse in the corrected position.

A cell saver device is often used to recover blood lost during the procedure, so that it can be returned to the patient. The spinal fusion procedure may be done using medications to reduce the patient's blood pressure in order to reduce blood loss and other medications that may reduce bleeding after the surgery is completed. These measures may allow the patient to avoid or reduce the need for donor blood transfusions.

Medically Reviewed by a Doctor on 12/13/2016
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