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The term scoliosis derives from the Greek word skolios, which means crooked. So, when we speak of adolescent scoliosis, we are referring to an abnormally curved or deviated spine in a patient between the ages of 11 and 18. To be considered scoliosis, the deviation or curvature has to be greater than 10 degrees.
When the curvature is more than 20 degrees, it is most often detected at an early age by observing asymmetries in the hips or shoulders, as well as deformities in the torso.
The scoliotic curve can occur for various reasons: congenital malformation of the bones of the spine, neurological disease, trauma, etc. But in more than 70% of cases of scoliosis, especially those that occur when a child is growing rapidly, the origin of the problem is unknown, so it is called adolescent idiopathic scoliosis. The word “idiopathic” also comes from Greek, with the root ‘idios’ (own) and ‘pathos’ (suffering), which we combine to mean an illness for which the cause is unknown.
The symptoms of scoliosis depend on how severe the degree of curvature is, and how long the patient has had the condition. This means that usually, affected children and adolescents do not suffer from back pain.
So, in these cases, often the only symptom is the visual perception of misalignment in the hips or shoulders due the deviation of the spine.
However, in cases with a very severely curved thorax, although this is less common, there may be respiratory or heart problems and other symptoms.
At Instituto Clavel, we make our diagnosis based on a thorough, overall examination. Tests include a low dose bi-planar scoliogram X-ray using the new EOSedge technology. With this scanner, we obtain a high-quality image of the complete spine of the patient that allows us accurately determine the magnitude of the scoliosis. This test is usually supplemented with an MRI of the entire spine.
In most cases, adolescent scoliosis is treated with conservative measures. However, this depends specifically on the degree of curvature of the patient’s spine.
In mild scoliosis, when the curvature is less than 20 degrees, the most common practice is to monitor the progression of the curve with regular checkups, and perform postural exercises to keep the muscles as toned as possible so that the curvature does not continue to progress. This kind of regular monitoring will allow us to act quickly if, for example, the patient’s curve were to worsen by 15 to 20 degrees between two visits and we see that there is a risk of the scoliosis becoming more severe.
In patients with curves between 20 to 40 degrees, the postural exercises can be combined with wearing a brace. This can be worn at night, or 24 hours a day, to help straighten the spine.
Surgical treatment to correct the scoliosis is only recommended in cases with a spinal curve greater than 40 or 45 degrees, where there is significant deformity affecting the patient's quality of life.
In scoliosis surgery, to straighten the curved segment of the spine, the surgeon makes a realignment and fuses the vertebrae as needed to stabilize the spine in its new position. How is this done? By placing transpedicular screws that connect to each other with metal rods to align the spinal column. We do this using various surgical techniques; for the instrumentation, we use a posterior approach, that is, through the back, and for the arthrodesis, we can access the spine using the anterior approach, that is, through the abdomen or through the rib cage.
The standard practice is for the surgeon to shape the rods while in the operating room, based on their experience. However, at Instituto Clavel, thanks to our previous planning of the surgery with the EOSedge scanner and the Keops software, we are able to design the correction in advance and then, using the Kheiron material, design the rods to custom fit the patient's spine. This allows us to obtain better surgical results.
Scoliosis surgery: advances thanks to surgical planning and customized rods
Before surgery, we make a precise analysis of all the angles and shapes of the patient's scoliosis, using the EOSedge scanner. After that, we make a three-dimensional reconstruction of the spine with the Keops software to simulate the final result of the correction and design the rods to measure for the patient.
During surgery, we use intraoperative navigation guided by O-Arm 2 or Loop X, which allows us to place the pedicle screws more accurately. We also have the Mazor X robot that increases the precision and safety of the surgery.
In order to align the spine, small cuts called osteotomies are made in the vertebral bones. We currently have ultrasound cutting technology, which allows our surgeons to perform the osteotomies with less blood loss.
At Instituto Clavel we have intraoperative blood salvaging equipment that allows blood lost during surgery to be continuously returned to the patient's bloodstream, decreasing the need for blood transfusions after surgery.
Continuous intraoperative neurophysiological monitoring is supervised by the neurophysiologist, a doctor who monitors the safety of the nerves and spinal cord throughout the operation.
With staged surgery, we can perform the previous correction of the curvature using the minimally invasive anterior or lateral approach, and then use the posterior approach later for placement of the transpedicular screws. By performing the surgery on different days, we reduce the patient's trauma and facilitate postoperative recovery.
These surgeries are complex and highly specialized, so a multidisciplinary professional team is needed. That’s why at Instituto Clavel, our scoliosis team includes almost all the members of the medical team: nurses, physical therapists, traumatologists, surgeons, neurosurgeons, neurophysiologists, anesthesiologists, the intensive care team and the doctors of the pain clinic.
Young patients usually recover quickly. After surgery, they spend one or two nights in the ICU and, usually, after 7-10 days in the hospital, they return home. However, they will have already begun to move around while in the hospital, and they will go home walking on their own two feet.
After surgery, our medical team will recommend specific rehabilitation for your case, which can include both manual and active physical therapy.
Contact us so that we can give you a personalized assessment.
