Adolescent Idiopathic Scoliosis
Before and After Cases
What is Adolescent Idiopathic Scoliosis?
This type of scoliosis typically occurs in adolescent females but can also affect males. Scoliosis is defined as curves greater than 10 degrees. Once a curve has progressed to 45-50 degrees surgery may recommended by your surgeon. Curves typically progress at a rate of 1 degree a month during the adolescent growth spurt (with the fastest rate of progression just before the start of menses or puberty).
There are no activities or exercises that a patient can do that will worsen the curve or improve the curve. We encourage our patients to remain active in their sports and activities.
In children who are still growing and have curves between 25 degrees and 40 degrees bracing may be considered. Bracing will not correct the present curve but will hopefully prevent the curve from progressing to where surgery would be needed (50 degrees). It is not known whether braces really work or not.
Posterior Spinal Fusion
Once a thoracic curve reaches 50 degrees or a thoracolumbar curve reaches 45 degrees surgery may be recommended to correct the deformity and ultimately prevent the curvature from progressing into adulthood. If a curve is under 45-50 degrees at the end of skeletal growth than the curve has a very low likelihood of worsening into adulthood and should not cause any more problems for the patient as an adult. However once a curve reaches 45-50 degrees studies have shown that those curve will progress at a rate of 1 degree a year for the remainder of a persons life.
Our surgical patients will spend 5-7 days in the hospital after their surgery. The physical therapy team will help them get up and out of bed on day 1 or 2 after surgery. The patients will have their pain controlled by our specialized pain team and will go home on oral pain medications. Generally our patients are out of school for 3-5 weeks after surgery. We allow light activities (walking, swimming, jogging, supported strength training) around week 3 and back to full sports by 3 months after surgery. Each case is different and we adjust this schedule based on each patient’s unique recovery.
After you are discharged home from the hospital we will see you back in the office at 2 weeks after surgery, 3 months after surgery, 6 months after surgery and one year after surgery. Than once a year follow-ups until the patient is skeletally mature. If all is going well then we may stretch out those yearly visits to once every 2 years.
After the surgery our patients generally return to all sports and pre-surgical activities by 3-4 months. We have had patients play sports in college for basketball, volleyball, and soccer. We have a number of gymnasts who continue long careers after their fusions.
Anterior Spinal Fusion
A fusion can be preformed on a smaller portion of the spine from the side of the body. This approach leaves a less noticeable scar for the patient and preserves more flexibility of the spine after surgery. Only a select amount of curves can be corrected with this technique.
Major Thoracic Curve
Image A: This patient, JM, is an example of a solitary thoracic fusion for a major thoracic curve.
Image B: X-Ray image shows spine with hardware post-surgery
133 Degree Scoliosis of the Thoracic Spine
Image A & B: Patient CG with a 133 degree scoliosis of the thoracic spine. She has a large deformity of the spine when standing. Curves this big may require a staged posterior spinal fusion to obtain the maximum amount of correction without causing trauma to the spinal chord. This technique uses a temporary rod which is placed at the first surgery. Then, a week later, permanent hardware is placed.
Image C: Post operative x-rays shows good correction.
Image D: Above is patient two weeks after her final fusion surgery.
Image E: Six months after staged posterior spinal fusion. Patient regained her pre-operative weight, is four inches taller and much happier!
48 Degree Right Lumbar Curve
Image A: This patient, YT, had a single 48 degree right lumbar curve.
50 Degree Primary Lumbar Curve
Image A & B: Patient YH has a primary lumbar curve measuring 50 degrees. Notice the asymmetry of her hips.
Image C & D An anterior fusion was performed on the lumbar spine. Notice how balanced her waist is compared to the pre-operative films. Even with a slight curve above the hardware patients shoulder are level.
Single 61 Degree Right Lumbar Curve
Image A and B: Patient EW has a major 61 degree right thoracic curve that was corrected by fusing the thoracic spine only. This maintains the lower spines movement.
Large Scoliosis of Thoracic and Lumbar Spine
Image A & B: Patient AZ with a large scoliosis of the thoracic and lumbar spine. Patient has a large asymmetry at her waistline and a large left-sided rib hump with forward bending.
Images C & D: Two months after surgery, the hardware is in place and the patient is well balanced with her waistline more level.
Image E: Two months after her posterior spinal fusion surgery, showing the hardware from the side.
57 Degree Right Thoracic Curve and 62 Degree Left Thoracolumbar Curve
Image A: Patient HJ before surgery to correct the 57 degree right thoracic curve and the 62 degree left thoracolumbar curve.
Image B: patient's spine 3 days after surgery showing a great correction of both curves.
Image C & D: The x-rays show the spine from the side before and after the same surgery.