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Mayo Clinic Q and A: Scoliosis treatment options

Cynthia Weiss, Mayo Clinic News Network on

Published in Health & Fitness

DEAR MAYO CLINIC: My granddaughter was diagnosed with a severe case of scoliosis. What is scoliosis, and what treatments are available?

ANSWER: Scoliosis is a side-to-side curvature of the spine that can occur in about 1 in 300 children. In growing children, curves can progress rapidly, especially during the adolescent growth spurt.

Growth plates, which are compressed, grow more slowly, resulting in progressive wedging of the vertebra and scoliosis progression. Large curves can continue to progress slowly in adulthood, eventually causing problems with quality of life and even breathing.

Typically, braces can be prescribed to treat mild or moderate curves by holding the spine in a corrected position while the spine grows. Bracing may prevent the curve from worsening, but it does not typically straighten the alignment of a curved spine.

For some children, the curvature of their spine is significant, thus the diagnosis of severe scoliosis. Severe curves can be treated with spinal fusion. This reliable and successful procedure, which has been around since the 1960s, prevents the curve from returning.

With spinal fusion, an 8- to 12-inch incision is made over the back, and the muscles are moved out of the way to reach the spine. Screws and rods are attached to the curved area of the spine, and the spine is pulled into a corrected position. Then small joints over the back of the spine are removed, and the bone is roughened with a high-speed burr.

 

This process creates a solid sheet of bone or a fusion across the back part of the spine. Depending on where the curve is, between six to 13 vertebrae of the 17 vertebrae in the back are fused to treat scoliosis, with anywhere from 14 to 24 screws and two solid metal rods being used.

After fusion however, the spine no longer grows over the area where the spine is fused, and the spine does not move over the area that is fused. In most cases, the unfused area of the spine can compensate, and children have normal function and acceptable spine motion. After a fusion surgery, children are in the hospital for three to four days and could miss about three weeks of school. Most children can return to normal physical activity and play most sports within 12 weeks after surgery.

In rare cases, patients will require a second surgery. Based on research, only about 2% of patients need a second surgery within the two years of the first procedure.

Once a fusion surgery is performed, there is no reason to perform a nonfusion procedure. However, newer surgeries that do not involve fusion are available to treat scoliosis.

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