What is scoliosis?
A lateral curvature of the spine from side to side forming a “C” or “S”
shape curve with the Cobb angle of more than 10°
Types of Scoliosis
| Idiopathic | Other causes |
| Infantile (IIS) 0-3 years old | Congenital |
| Juvenile (JIS) 3-10 years old | Syndromic |
| Adolescent (AIS) 10 – 18 years old (Most Common) | Neuromuscular Disease |
Do I have scoliosis?
Systoms and signs of idiopathic scoliosis include:
- – Abnormalcurve of the Spine
- – Uneven shoulders
- – Prominent shoulder blade and rib cage, especially when bending forward
- – Uneven hips
- – Difference in Leg length
- – Abnormal walking pattern
Treatment Options
| Cobb Angle (X°) | Mode of Treatment |
| 10 – 20° | Observation with follow-ups |
| 20 – 45° | Brace |
| > 45° | Surgery |
Surgical Treatment
Surgical treatment is reserved for scoliosis curves > 45 degrees
Aims:
i) Tp prevent worsening of the curve
The figure above shows the progressive worsening of the curve over a year
in one of our patients who is immature/prepubertal
(before first menses / period)
ii) To straighten the spine (correction rate between 50-75%)
iii) To prevent deterioration of the lungs and create more abdominal space
iv) Better cosmesis
How is the surgery performed?
Posterior Spinal Fusion
Multiple pedicle screws are inserted into the spine from the back and are
connected by rods to straighten the spine
The surfaces of the bones are rawed and bone grafts (from patient’s bone)
are laid on it
The initial spine stability is provided by screws and rods, but as soos as
the patient’s bone grows, it would be strong enough to maintain the spine
in a straight position.
What are the risks of surgery?
The overall complication rate (major and minor) is approximately 5%
The table below describes all the major and minor complications that arose in posterior fusions for AIS as reported by SRS in 2006
| Type | Posterior (%) (Number of patients = 4369 |
| Wound Infection | 1.35 |
| Pulmonary (not pulmonary embolus) | 0.96 |
| Implant related | 0.64 |
| Neurologic | 0.32 |
| Dural Tear | 0.18 |
| Nonfatal bleed | 0.14 |
| Deep Vein Thrombosis | 0.05 |
| Pulmonary embolus | 0.02 |
| Blood loss (fatal) | 0.02 |
| Air embolus (fatal) | 0.02 |
In our centre, the major complication rate is less than 0.5% (Based on the scoliosis database in University of Malaya)
What happens if you do not undergo surgery?
There will be and increased risk of developing a larger curve leading to loss of body balance
Generally there are 3 different groups if curve progression:
| Group | Outcome |
| Immature / prepubertal patients (before 1st menses / period) | Curve will progress very aggressively |
| Immature / postpubertal patients (after 1st menses / period) | Progression is approximately 5-10 degrees over a year |
| Mature (after attaining skeletal maturity) with curve > 50 % | Progression is approximately 1 degrees over a year |
When the curve reaches 100 degrees or more, the risk of lung/heart failure is higher; which may lead to death at an earlier age.
How long will the Operation take?
Operation will take Approximately 3 hours.
How would the Patient deal with the Post Operative pain?
The post operative pain will be controlled using multimodal pain relieve techniques which includes patient controlled analgesia , oral anti inflammatory and analgesic agents and local infiltration of pain relieving medication at the wound site
When will the patient be able to get up and walk for the first time after surgery?
Usually within 24 hours
How many days do the patients stay in the hospital?
3 – 4 days.
When can I Return to School?
You Will be able to return to school in approximately 3 to 4 weeks
How soon the patient will be able to return to normal activities after surgery?
3 – 4 months
Can the patient participate in sports?
Yes, but preferably no contact sports for the first 12 months.
For female patients, does scoliosis surgery affect pregnancy in the future?
NO