Scoliosis is more than just poor posture.

The disease is a fixed curvature of the spinal column to the left or right side.

Moreover, it is accompanied by the rotation of the vertebrae around the vertical axis.

With a severe degree of the disease, physical therapy, massage and physical therapy are not enough.

It is possible to correct the pathology only through surgical treatment .

Stage 3-4 clearly require surgical intervention.



Features of the course of the disease

The vertebral column is a complex anatomical structure. It is the foundation of the human skeleton and the protection of the spinal cord. Therefore, problems in the spine inevitably affect the functioning of all body systems.

The main causes of scoliosis can be :

  • Congenital malformations of the spine.
  • Congenital abnormalities in the development of the skeleton (one leg is shorter than the other).
  • Diseases of the skeletal system.
  • Injuries.
  • Spine changes associated with old age.
  • Physical inactivity, forced to be in one position for a long time.
  • Overweight.
  • Infectious diseases of the spine (poliomyelitis).

The disease has four stages, characterized by different angles of curvature :

The first angle up to 5 degrees
The second angle 5-40 degrees
Third angle 45-60 degrees
Fourth angle over 60 degrees

 

The progression of the disease is observed in childhood and adolescence. Insufficient physical activity leads to weakness of the muscular system. Added to this is a long sitting at a desk, a heavy briefcase, and increased skeletal growth during puberty. As a result, scoliosis develops.

In adults, the disease does not progress. There is only age-related subsidence of already curved vertebrae. Therefore, at a later stage of the disease, they are diagnosed: wedge-shaped vertebrae, curved vertebral arches and processes, a large degree of curvature. These age features are taken into account when choosing an operation.What can physical therapy do for your scoliosis?

Indications for surgery

Surgery to eliminate scoliosis is often the only way to deal with the disease. With its help, the patient can return to normal life, restore mobility, get rid of pain, and eliminate a cosmetic defect.

In most cases, they try to carry out conservative treatment of the disease, especially with grade 1-2 scoliosis.

Direct indications for surgery are :

  • The curvature of the spinal column more than 45 degrees.
  • Disorder of the internal organs caused by scoliosis.
  • Aesthetic defect.
  • Pinched nerve endings causing partial paralysis.
  • Severe pain syndrome, which cannot be stopped by conservative methods.

Also, the operation is prescribed for children who have rapid development of scoliosis. The purpose of surgery is to correct the curvature and prevent further development of the disease.



Important! The age of the child should be taken into account. If the operation is performed too early, it can negatively affect the further development of the skeleton. The optimal age is considered to be 16-18 years old, when the formation of the spinal column is completed.

The goals of surgery are :

  • Maximum correction of a cosmetic defect.
  • Elimination of pinched nerve endings.
  • Removal of pain syndrome.
  • Prevention of further development of the disease.

The key to a successful operation is the correct choice of technique and the absence of concomitant diseases in the patient.

Operation methods

With scoliosis of 1 and 2 degrees in 96% of cases, they try to do with conservative treatment. Exceptions are congenital malformations of the spine. Which can aggravate the patient’s condition?

Scoliosis of 3 and 4 degrees is treated promptly. For this, the following types of surgical intervention are used :

  1. With rear access. The incision is made in the midline of the torso. The advantages of this type of surgery are less trauma. However, it is not always possible to achieve complete correction of the cosmetic defect.
  2. Front access. The incision is made in the region of the ribs, one rib is removed and subsequently used as a natural fixation material. The disadvantage of this method is great trauma, scars on the chest, and abdominal cavity. But these operations are more preferable in a cosmetic sense.

Types of operations

Posterior fusion

It is used in the treatment of mobile scoliosis, mainly in young people. During surgery on the curved vertebrae, the processes and the cortical bone layer are squeezed. An implant in the form of bone chips is placed in its place. From above it is covered with muscles. As a result, all parts of the bone grow together safely.

After the operation, the patient needs bed rest for 4 months and being in a plaster corset. Only then is he allowed to get up. The corset is replaced with an orthopedic one.

Posterior fusion with thoracoplasty

This operation is performed when scoliosis has provoked a curvature of the chest and ribs. The technique is similar, only several ribs are additionally cut off. As a consequence, the chest cavity is leveled.

Iliospondylolavsanodesis

This operation is performed with immobile scoliosis. First, you need to correct a stable curvature, then apply the fixation block. A kind of “jack” here is a lavsan tape, which does not need to be removed later.

The tape is fixed so that it straightens the arch of the spine with its tension. After the operation, the patient is also in a plaster brace in a special corrective bed. After three months, the corset is changed to orthopedic, which is worn throughout the year.

Often, scoliosis is severe, provoking changes in the shape and anatomy of the vertebrae.

In these cases, the following operations are prescribed.



Discotomy

This is the removal of the vertebral disc. First, the transverse processes are removed, then the fibrous rings of the discs are dissected. After the operation, the patient is in a plaster corset for a year.

Episode

Destruction of the vertebral body. It is carried out with rapidly developing scoliosis in children. A part of the disc, the nucleus pulposus, is removed. The bone crumb is applied to this place. First, the patient is placed in a plaster bed, then a plaster corset is put on. After 3-4 months, the corset is replaced with an orthopedic one and they are allowed to walk.

Wedge resection

Its essence is to remove the convex part of the vertebrae. Also requires a long stay in a plaster bed and corset.

The above methods are very traumatic and require a long rehabilitation period. The patient “drops out of life” for at least a year.

Today, many modern clinics offer the latest scoliosis treatment methods. The advantages of the techniques :

  • No transplant required.
  • No big cuts.
  • The cortical bone is not removed.
  • Reducing the recovery period to several weeks.
  • The possibility of carrying out in children.

These operations are based on the establishment of special spinal structures that act as a “jack”, stretching the spine and correcting the curvature.

Screws are screwed into the arches of the vertebrae to the patient , on which a metal plate is then installed. This plate is the frame for the spine. The vertebrae are pulled by the screws and the spinal column is straightened. The plate is located in the subcutaneous layer and does not interfere with normal life. After alignment, it is removed.

The only disadvantage of such treatment is the high price . Not all medical institutions provide this service. A high qualification of a surgeon is also required.

Rehabilitation and prognosis

The rehabilitation period after traditional surgery is very difficult and long. Relatives need to prepare for long-term patient care.

The patient is placed in a plaster bed. X-rays are taken after 10-12 days. If the operation is successful, then put on a plaster corset. Strict bed rest is shown for several months. Then the plaster corset is changed to orthopedic , which is worn for up to a year.

Rehabilitation is much faster after the installation of titanium structures.

  • The patient spends the first four days in bed. Small movements are allowed to prevent thrombosis.
  • After 10 days, X-rays are taken, in case of normal healing, they are allowed to walk around the room.
  • I write home in 12-15 days, provided I feel well.
  • You can sit only after three months.
  • In most cases, the patient must wear a corset for several hours a day to relieve stress on the spine.
  • For six months, sharp inclinations, turns, lifting weights (more than 3 kg) are prohibited.
  • After 6 months, an MRI scan of the spine is required to ensure that the recovery process is successful.

Any operation can lead to complications. With modern approaches to the treatment of scoliosis, the risk of complications does not exceed 5%.




Nevertheless, the possibility of negative consequences remains . It can be:

  • Loss of flexibility of the spine in the operated area.
  • Damage to the spinal cord or nerve roots.
  • Vein thrombosis.
  • Inflammation.

These problems can be easily avoided if the operation is performed in a good clinic with a qualified surgeon and a thorough preoperative examination is carried out.

Important! At stage 4 of scoliosis, the operation does not cure the patient 100%. The risk of relapse remains for life.

To avoid repeated problems with the spine, a person must adhere to certain rules throughout his life after surgery :

  • Do not sit in one position for a long time.
  • Do not lift heavy objects.
  • Do not make sudden movements.
  • Do not engage in sports that put stress on the spine (running, equestrian sports, weightlifting, etc.).
  • Perform a set of physical exercises to strengthen the muscle corset.
  • Swimming, yoga , walking are allowed.

In general, patients who have undergone spinal surgery quickly get used to the new lifestyle and do not feel left out.

Conclusion

Scoliosis is a serious pathology of the spine that significantly impairs the quality of a person’s life and can lead to disability.

To get rid of this problem with severe curvature, surgical treatment of scoliosis is performed.

Currently, preference is given to operations involving the installation of metal structures, with the help of which the spinal column is straightened.

Such operations are less traumatic and do not require long-term rehabilitation.

List of references

  1. Diseases of the spine and joints. L. Viilma – 2018.
  2. Diseases of the joints. V. Mazurov – 2017.
  3. The nature of the intelligent body. All about the spine and joints. S. Bubnovsky – 2019.
  4. System “Healthy spine”. V. Pikulenko – 2017.



Categories: scoliosis

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Why is scoliosis of the spine dangerous? · October 18, 2020 at 7:38 am

[…] SURGICAL TREATMENT OF SCOLIOSIS: WHAT SURGERY TO CORRECT SCOLIOSIS ARE THERE? […]

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