Scoliosis

Scoliosis is a deviation of the spine that can appear at any age, but usually appears in the paediatric population, especially in adolescents, manifesting in a deformation of the torso.

The shape of the human spine, seen in profile, is not straight. It has four natural curvatures, very important to distribute the effort required in the movement of daily activity: the cervical, thoracic, lumbar, and sacral curves.

When the spine, seen from the front, has an “S” shaped lateral curvature, scoliosis is present. This disorder can be suffered at any age. In children under the age of three, infantile scoliosis may be congenital due to neurological disorders or unknown causes.

Approximately 3 % of the adolescent population suffers from scoliosis, with a curvature of between 10 and 30 degrees.

Scoliosis can also appear in adults, which can be due to a degenerative process or a scoliosis that occurred in childhood that went untreated, thus carrying over into adulthood.

Symptoms may be seen on one shoulder or one side of the waist higher than the other. Mild curvatures are painless, so it is important to see a doctor when a child is seen to have symptoms of scoliosis.

When should scoliosis be operated?

Paediatric scoliosis should be operated on when it reaches a degree that will surely cause problems in adulthood. This is generally known as scoliosis over 50 or 60 degrees.

In adulthood, scoliosis is operated on when associated with pain that is not controllable with conservative treatment or when it shows a progressive worsening over time.

Scoliosis surgery in both paediatric and adult patients has been shown to be effective in improving the quality of life of these patients.

How is scoliosis surgery performed?

The intervention is carried out using a Southern approach: the patient is placed in a prone position (face down), with special protections to relieve pressure on the face and other supporting parts of the body, and the spine is reached through an incision made in the back.

In flexible deviations, it is basically a matter of stretching the column and, if it is flexible, it is usually put reasonably in place. With rigid deviations, the spine must be cut and corrected. Being a rigid structure, it cannot be straightened without making a series of cuts. The difficulty in treating these is that by sectioning the spine and correcting the deviation, the spinal cord that is housed in the spine must be kept from being damaged.

Therefore, these surgeries are always performed with intraoperative neuromonitoring: a neurophysiologist constantly monitors the state of the patient’s potentials, allowing the spinal surgeon to work with maximum assurance and reduce the risks of neurological injuries.

What the post-surgical procedure?

The first 24-48-72 hours after surgery are usually spent in recovery rooms or intensive care units. These are long surgeries in which the patient is admitted to these units to recover their most vital functions. The goal is to stabilise the patient from a haemodynamic and respiratory standpoint, and in terms of pain management.

Once the hemodynamic and respiratory stabilization is attained, and their general condition, the patient is transferred to hospitalisation. Here care is focused on monitoring and curing the wound to avoid infection, which is, in general, rare. Progressively, the rehabilitation and physical therapy team begins to mobilise the patients. Sometimes they are put in a protective brace.

What is rehabilitation like after scoliosis surgery?

Rehabilitation is not usually required. When it is needed, it is because the patients themselves have a prior associated respiratory or neurological disorder that requires assistance in order for them to recover normal functions. In general, neurologically healthy children who do not have associated diseases, only scoliosis, recover quite well without the need for very specific rehabilitation.

Types of scoliosis in children

Congenital (present at birth)

It appears during foetal development. Often caused by vertebrae that did not form normally; by a lack of vertebrae; by partially formed vertebrae; or by lack of separation of the vertebrae.

Neuromuscular

Associated with many neurological conditions. It happens especially in children who do not walk yet, and who suffer for example from cerebral palsy, spina bifida; muscular dystrophy; paralytic conditions; spinal cord tumours; or neurofibromatosis, among others.

Idiopathic

80% of cases. Its origin is unknown.

There are 3 types of idiopathic scoliosis:

– Infantile –

It appears from birth to 3 years of age. The curvature of the vertebrae is typically to the left and is most commonly seen in children. Usually the curvature disappears as the child grows.

– Juvenile –

It occurs in children between the ages of 3 and 10.

– Adolescent –

It takes place in children between the ages of 10 and 18. It is the most common type and is more frequent in girls.

Why trust Dr. Ferran Pellisé?

Because he specialises in scoliosis surgery, kyphosis, and high complexity spine surgery.
Because he has over 20 years of experience.
Because he performs over 70 scoliosis surgeries a year.
Because he takes care of patients of all ages: babies, children, adolescents, and adults.
Secretary elect of the Scoliosi Research Society.

-See full curriculum-

Escoliosis_ Dr. Ferrán Pellisé _Instituto de Columna Vertebral _Hospital Quirónsalud Barcelona

REAL CASES

HIGH COMPLEXITY SURGERY CORRECTING A SEVERE SPINAL MALFORMATION IN A 22-MONTH-OLD BOY

An exceptional case because of the age of the patient and the severity of the congenital scoliosis

The patient’s family visited Dr. Ferran Pellisé, Director of the Instituto de Columna del Hospital Quirónsalud Barcelona (Spine Institute of the Quirónsalud Hospital in Barcelona), after being told in their home country, Morocco, that there was no treatment for their son.

Iyad had a greater number of vertebrae on the left side of the spine and a lack of vertebrae on the right side, resulting in the asymmetrical growth of the spine, with much more growth on the left side than on the right side and progressive deformation of the spine and torso as he grew.

Given the complexity of the surgery, which was financed by the Moroccan Government, a three-dimensional model of the child’s spine and ribcage was made in order to perform the surgery with maximum success.

Surgeons removed the malformed vertebrae, repositioned the spine and chest with mini-screws and corrected the scoliosis without damaging the spinal cord.

Iyad’s postoperative period did not have any complications, although his evolution should be monitored to continue guiding the growth of Iyad’s spine until he is older, as it may have a tendency to twist again given its characteristics and malformations.

Hernia discal | Unidad de Columna Dr. Ferran Pellisé / Barcelona Spine Institute

Slipped disc

A 45-year-old patient was operated on for a slipped disc after 7 weeks of sciatic pain. The patient’s surgical scar a few weeks after the operation can be seen in the photograph, by which time the patient had returned to work.

Fractura de columna | Cirugía de Columna - Dr. Ferran Pellisé

Fracture

Sometimes surgery is essential to treat vertebral fractures, as in this case with displacement of bone fragments and nerve damage. The photos show the situation before the operation and 6 years afterwards, when spinal function and alignment had been restored.

Espondilodistesis | Unidad Columna Barcelona Spine Institute

Espondilolistesis

A 12-year-old patient with severe spondylolisthesis and nerve compression was treated with decompression, correction and stabilisation procedures. The photos show the appearance of the patient and the vertebral displacement before and after surgery.

Adult scoliosis

Scoliosis surgery in adults allows the torso to be realigned and the patient to function better. The photos show the realignment of the torso and correction of the deformity as a result of the operation.

Escoliosis adolescente | Unidad de Columna - Cirugía Dr. Ferran Pellisé

Adolescent scoliosis

Scoliosis surgery has very good results in adolescents. In all three cases you can see the improvements in the torso and the deformity as a result of the operation.

Spinal stenosis

50-year-old woman with lower back pain radiating to the legs due to L4-L5 spinal stenosis, which prevents her from walking or standing for prolonged periods. The photo shows the pre-operative magnetic resonance imaging and the result of decompression surgery with instrumentation. This technique has very beneficial results which persist over time.

REQUEST AN APPOINTMENT

Scoliosis

REAL CASES

WHERE ARE WE?