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Deformity and Scoliosis

Making the Right Choices in the Treatment of Idiopathic Scoliosis: A Patient's Guide - Appearance

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Deformity and Dissatisfaction with Appearance

Progressive deformity and dissatisfaction with appearance are also important concerns for patients and family members. At least half of all adults with scoliosis identify dissatisfaction with appearance as the reason for seeking surgical care. Accurate data on the psychosocial effects of scoliosis and deformity on self-image and social role are limited, and largely individualized. Long-term studies demonstrate a poor correlation between the location or degree of a curve and the extent of psychosocial complaints. For patients with AIS, the influence of surgery for deformity on self-image and satisfaction with appearance varies and is difficult to predict. Surgical treatment of deformity does not have a reliable effect in improving self-image or satisfaction with appearance.

small boy and father piggyback ride

Neurologic Compromise

Progressive neurological deterioration is not characteristic of adolescent idiopathic scoliosis, and development of late parapelegia is extremely rare. Degenerative changes of the spine associated with adult deformity may lead to progressive radicular pain patterns or to spinal stenosis. Congenital deformity and scoliosis due to neuromuscular syndromes are characterized by progressive neurologic deterioration with curve progression. The presence of a neurologic abnormality with scoliosis will alert the care provider to look for an intraspinal abnormality as neurologic disturbance is not a characteristic sequelae of idiopathic scoliosis.

Surgical Techniques

Surgical techniques continue to evolve in the management of scoliosis. For certain curve types the surgeon is able to gain significant curve correction while preserving much of the mobility of the spine. Minimally invasive techniques also allow us to minimize the morbidity of anterior approaches to the spine. In considering early surgical management options for AIS, one advantage is the availability of techniques for minimizing fusion levels that may not be useful in later stages of the deformity. Again, patients and families' discussion with the care provider should include an understanding of whether continued non-operative care may compromise future surgical options.

Conclusion: Choices in the management of AIS should be made with participation of the patient, family, and care provider. The goal of this article is to outline a few of the topics that are important in considering management options, and to encourage the readers to pursue more information with their care providers. Without information, choices cannot be made, and management becomes prescribed. Ultimately an informed patient who participates in management decisions is most likely to be satisfied with the outcome of management.

doctor, child, hospital exam room

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Updated on: 02/01/10
Dr. Berven has provided the reader with an overview of scoliosis developing in the skeletally immature adolescent. The important fact to remember is that only a small fraction of adolescent patients who develop a curvature of the spine will ever require treatment other than periodic observation during the growth period. It is however important, once scoliosis has been diagnosed or is suspected, to be seen by an orthopaedic surgeon, who specializes in spinal problems in children to determine the severity of the deformity by an examination and x-rays and what, if any, treatment is indicated.

Most of the time he/she will recommend periodic follow-up examination during the growth period until growth is complete. Exercises alone have never proven helpful in the treatment of scoliosis. A small number of patients (<0.5%) will require the use of a back brace combined with an exercise program during growth, however the brace, if needed can be removed for daily athletic activities and exercise. Braces are now available which are cosmetically acceptable and easy to wear. Braces often will control curves <40º but a few will increase and require surgery. An even smaller number (<0.25%) with curves greater than 40º- 45º may require surgical correction of their scoliosis. When surgery is necessary, the use of a brace is rarely needed and present surgical techniques are usually very successful.

As Dr. Berven suggested, always discuss treatment options with your orthopaedist so that you thoroughly understand his/her recommendations and seek other opinions if he/she is unable to explain recommendations.

Baron S. Lonner, MD
Dr. Berven provides an excellent review of the management of adolescent idiopathic scoliosis that emphasizes the importance of informed decision-making by the patient, family, and surgeon. New treatment options in AIS include the possibility of modulating or controlling growth of the spine by causing differential growth on one side of the spine more than the other to allow for gradual correction of the scoliosis with growth. This approach, utilizing "staples" or flexible tethers placed by minimally invasive techniques would be utilized in patients who continue to grow and in whom bracing has failed. Flexibility of the spine is preserved by theses techniques. This is currently an experimental area.

Results of surgery in the adolescent patient have been predictable and quite good. Goals of surgery include correction of deformity, preservation of pulmonary (lung) function, avoidance of long-term pain as a consequence of untreated curvature, and preservation of as many motion segments of the spine as possible. Studies assessing outcomes of surgery in patients have shown high rates of satisfaction and improvements in self image, pain, and even function.

Dr. Berven should be congratulated on his approach to patient care based on informed decision-making and inclusion of the patient and family in the process of devising a treatment plan.

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