When there is a confirmed diagnosis of scoliosis, there are several issues to assess that can help determine treatment options:
- Spinal maturity – Is the patient’s spine still growing and changing?
- Degree and extent of curvature – How severe is the curve, and how does it affect the patient’s lifestyle?
- Possibility of curve progression – Patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.
After these variables are assessed, the following treatment options may be recommended:
- Minimally Invasive Surgery
In adults with scoliosis, x-rays are usually recommended once every three to five years, unless symptoms are getting progressively worse.
Braces are effective only in patients who have not reached skeletal maturity. In adults, it is usually prescribed only for brief periods of time to help with acute back pain symptoms.
Minimally Invasive Surgery (MIS)
Fusion can sometimes be performed via smaller incisions through MIS. The use of advanced fluoroscopy (x-ray imaging during surgery) and endoscopy (camera technology) has improved the accuracy of incisions and hardware placement, minimizing tissue trauma while enabling an MIS approach. It is important to keep in mind that not all cases can be treated in this manner and a number of factors contribute to the surgical method used.
Most patients with adult scoliosis do not require surgery. Surgery is considered for more significant deformities that are clearly progressing and those causing symptoms.
Pain control is the usual reason for surgery for scoliosis in adults. Surgical intervention may include the removal of an intervertebral disc combined with spinal instrumentation and fusion. This typically involves a posterior approach to the spine and occasionally an anterior approach, as well. Spinal instrumentation utilizes rods, wires, screws and other types of medically designed implants. Combined with fusion, instrumentation stabilizes spinal segments, enhances fusion, and provides a more permanent solution. These procedures may enable the patient to sit upright thereby reducing the risk for cardiopulmonary complication, and may also increase mobility. This type of surgery can be performed safely on adults with spinal deformity, usually with excellent results. In general, both surgery and recovery time are expected to be longer in older adults with scoliosis.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of scoliosis patients benefit from surgery, there is no guarantee that surgery will stop curve progression and symptoms in every individual.