The main purpose of surgical treatment for scoliosis:
First, to correct the scoliosis deformity, improve the function of the heart, lungs and abdomen, and expand the volume, scoliosis can cause shortened trunk deformity, causing the storage space of the thoracic and abdominal organs to become smaller.
The impact of lung function: the thoracic cavity volume becomes smaller resulting in incomplete lung development, the lung does not have enough space to expand, the lung can not open, so that the lung development is incomplete, but this is also related to the severity of scoliosis. Generally greater than 70 degrees or the thoracic segment of the spine appears anterior convexity, there will be obvious lung dysfunction, the reserve compensatory function of the lung is poor, such children are prone to colds, long duration of illness, long delay, can not participate in strenuous physical activities.
Effects of cardiac function: The volume of the heart in the chest cavity is limited and cannot be fully expanded, such patients are also greater than 70 degrees or when the thoracic segment of the spine appears anteriorly convex, manifesting as an inability to participate in strenuous activities and a fast heart rate, mostly above 100 beats. x-ray films show an obvious flat chest.
Effects on gastrointestinal function: The abdominal volume becomes smaller, so that the stomach and intestines cannot be fully expanded and squeezed, resulting in poor diet, long-term emaciation, poor physical condition and susceptibility to disease.
But surgery is not the perfect choice, but surgery is currently a helpless and effective choice for scoliosis.
Second, to increase confidence and improve the future and fate of the child.
In the long run, scoliosis itself is not important; what matters is the child’s future. Once the patient has a deformity of the trunk, resulting in high psychological stress, susceptibility to autism, isolation, irritability, reluctance to interact with others, and reduced ability to get along and communicate with others, have a profound impact on the child’s future: choice of spouse, employment, schooling, income, social status, etc. In North America in the 1970s and 1980s, a large number of prospective follow-up studies were conducted on patients with and without scoliosis, including patients with scoliosis, and after 10-20 years of follow-up comparisons, it was found that patients with scoliosis treated surgically had significantly better quality of life, education, social status, economic income, career satisfaction, marriage and family, interests, and communication skills (The survey was conducted as a large sample, and the results of the survey were not available. (The survey is a large sample census and does not involve individual cases).
Through the follow-up of my postoperative scoliosis patients, scoliosis surgery is particularly critical to improve the psychological status of patients. Many parents wrote to tell me that before his child was discharged from the hospital and had surgery, she was on summer vacation, never went out to play with her peers, was afraid that people would laugh at her, and was bored at home all day and did not like to talk. After the surgery, the patient was like a different person, cheerful, brave to answer questions in class, often went out to play with classmates in the summer and winter, and liked to socialize, and had positive changes in personality and body and mind.
The most common age of onset is between 10 and 16 years old, because spinal deformities continue to increase as the spine grows, so the earlier they are detected and the earlier they seek medical attention, the higher the cure rate. The initial diagnosis is usually made through the patient’s family history, developmental status, neurological examination, and the Adam’s Test for trunk symmetry. A spinal x-ray is then performed to determine the location and degree of curvature of the spine, as well as the degree of spinal development (RisserSign), and finally to determine the course of treatment. In addition, doctors will use spinal x-rays to measure the degree of scoliosis by Cobb’s goniometry. Generally speaking, scoliosis is not clinically classified as 10 degrees or less, but scoliosis is called scoliosis when the angle of scoliosis is greater than 10 degrees. And 10-20 degrees is mild scoliosis, 20-40 degrees for moderate scoliosis, more than 40 degrees is severe scoliosis.
Generally, for patients with 10-20 degrees of scoliosis, doctors will treat them in a more conservative and non-invasive way, including exercise, physical therapy and X-ray follow-up every 6 months.
Patients with 20-40 degrees of scoliosis may still be treated by conservative methods, including exercise, physical therapy, spinal joint correction, but need regular monitoring every 4 months X-ray, because the chance of deterioration is greater, in addition to conservative treatment will be combined with wearing orthopedic brace (Bracewear). (Especially for those with incomplete development).
Scoliosis above 40 degrees is a more serious patient, because if the condition deteriorates rapidly, it will seriously compress the chest cavity and affect the heart and lungs and other organs. Generally, surgery is required. (However, it is necessary to consider whether the patient has completed development).
In short, if conservative treatment cannot be used to correct or maintain scoliosis, surgical treatment must be considered to correct and inhibit the deterioration of scoliosis. The following are the conditions for surgical treatment.
Progressive spinal curvature with rapid deterioration
Severe trunk deformity (regardless of spinal maturity)
Severe pain (especially in older patients)
Facing cardiorespiratory failure
Hereditary severe scoliosis
Family and patient requirements for cosmetic appearance
In summary, in cases of primary scoliosis, surgery is required if the patient’s spinal curvature exceeds 40-50 degrees despite wearing an orthopedic brace. In addition, surgical considerations include the pattern of curvature, trunk imbalance, and skeletal maturity. The goal of surgical treatment is to correct the deformity as much as possible while preventing further progression of the curvature of the spine through internal fixation of scoliosis and spinal body fusion. In order to prevent the curvature from worsening, the cushioned tissue of the curved spine is removed and filled with a strong bone square and fused to create a straighter spine. The fixation system uses fixation devices such as links, plate hooks, metal wires and pedicle nails.
Principles of treatment for idiopathic scoliosis
For idiopathic scoliosis, non-surgical and surgical treatment should be selected based on age at the time of deformity development, rate of development, degree of scoliosis, degree of growth and development, cosmetic deformity, trunk balance and future developmental trends. However, the general treatment principle is to choose non-surgical treatment as much as possible before the termination of pubertal development; in patients who must be operated before, we should also adopt non-surgical treatment options first to delay the age of surgery.
Non-surgical treatment is an early means of treating scoliosis, with the aim of preventing the aggravation of scoliosis, avoiding the development of thoracic deformities, and avoiding serious visceral irritation such as cardiopulmonary, gastrointestinal, and genitourinary symptoms. There are many different methods, such as orthopedic, massage, physical therapy, suspension traction, bracing, etc.
The surgical treatment is for patients who do not have good results from non-surgical treatment and who have obvious symptoms of visceral irritation due to excessive scoliosis, and the cobb angle of 40 degrees is used as the criterion for choosing surgical treatment. However, in practice, the doctor’s decision to choose surgery and what surgical option to use also takes into account the patient’s bone age, growth and development status, type of curvature, structural features, rotation of the spine, the number of spines involved, the distance between the parietal vertebrae and the midline, and, in particular, the appearance of deformity and trunk balance.