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Scoliosis surgery; is it worth the cost?
Sometimes the remedy can be worse than the disease


Dr Kevin Lau D.C

It is about a ten-hour surgery in which they open you up on your side and on your back. In my particular surgery they would put three rods in my back and hold them together with five screws….In order to help my bone grow they took out one of my ribs and six of my discs, and they also took a bone graft from my lower hip (right on my butt). They took this bone and filled three cages that hold the bone which are in between the vertebra…..

Culled from Scoliosis Surgery: Corey McConnell's Experience

f it sounds, gruesome, remember this is just the beginning. Corrective spinal surgery for scoliosis can be quite a distressing experience for adolescent patients and their parents.. Spinal surgery often involves an extensive amount of tissue and bone trauma that can result in excreting pain that the patient simply has to live with.

Worse, there is no guarantee that despite the steep cost of spinal surgery, the results would be as expected. In many cases, the remedy can be worse than the disease.

Then why do so many scoliosis patients continue to opt for spinal surgery?

That’s a million dollar question! I’ve been baffled by it and discovered that over these years, we have veered so far away from conventional modes of treatment and scalpel-free, quick-fix cures, that we’ve forgotten that there were “miraculous” recoveries from scoliosis even when doctors didn’t wield any scalpel.

This set me on an intensive search and during my last few years of practice and experience with hundreds (if not thousands of scoliosis patients), I’ve come to discover that THERE ARE, time-tested non-surgical treatment for scoliosis, whose knowledge is complete (or shall I say, deliberated) obliterated by the proponents of modern medicine.

I’ve been offering a combination of these safe and painless non-surgical treatments for disorders of lumbar spine to my patients at Orchard Clinic in Singapore since 2005 and an year later, won the "Best Health-care Provider Awards" by the Straits Time on October 18 2006.

My techniques draws the best protocols and methods from around the world, namely the Schroth method pioneered in Germany to the Vertetrac system developed in Israel, besides vibration therapy, physical therapy and the use of Meditrac (a special device based on the Vertetrac system) for correcting spinal curves (scoliosis), low back pain, sciatica and herniation, with very encouraging results.

The biggest advantage with my treatment is that besides being painless, it’s more cost-effective (costs a fraction of the cost of spinal surgery) and there are no side effects! The only requirement is that you begin your treatment in advance, in right earnest. (See the inset table for a detailed comparison of spinal surgery with non surgical intervention)

I once saw a patient who was diagnosed with scoliosis in 1996 during a regular check up at a school camp but was NOT offered any treatment, except for general monitoring of the progression of her spinal curvature through annual X-Rays and the prescription of glucosamine to ease her pain!

The result?

While in 1996 her curvature was only 10-20 degrees that could easily have been set right at that age, when the tissue is still soft, growing and amenable, by 2003, when she finally came to visit me, the curve had progressed to 39 degrees to the right (thoracic) and 27 degrees to the left (lumbar). Obviously, to correct this kind of curvature, at her advanced age took more time and careful intervention and the progress was also slower than what it would have been had she been brought to me earlier.

Nonetheless, she started with my program with a lot of commitment and steadfast devotion (She hasn’t missed a single appointment with me in all these years!)in 2003. At that time, she suffered from acute backaches after sitting or standing in one posture for long. However, with the comprehensive program at my clinic, her condition gradually started improving. Over time, her right thoracic curve improved by 9 degrees from 39 to 30 degrees, while the left lumbar curve went from 28 to 27 degrees. “My back doesn’t feel as stiff and the frequency of backaches have decreased. Thank you, Dr Lau,” she wrote in my feedback book, one day.

My treatment basically includes:

Nutrition therapy
I am a firm believer in that age-old dictum: We are what we eat. In the past couple of decades, an over consumption of “junk foods” has completely compromised our natural gut response and given birth to many lifestyle-related, degenerative diseases. Rather than offering a one-size-fit-all diet program to my patients, I customize it to their unique biomedical needs, as I believe that the metabolic response to food is different for different people.

Posture & Body Balance Training

There is now a huge body of research on outpatient physiotherapy, intensive inpatient rehabilitation, and bracing that’s proven the effectiveness of exercise in scoliosis treatment. A paper from researchers in Turkey published in the Saudi Medical Journal on Schroth’s three-dimensional exercise therapy --- that I use at my clinic for adolescent idiopathic scoliosis --- found that after six weeks, six months and one year, of therapy, all patients had an increase in muscle strength. What’s more, they also reported a significant improvement in their postural defects.
I however do a thorough radiographic evaluation before prescribing a personalized exercise regime, a precise “blue print” to work from to each of my patients. These specific exercises that I devise for each of my patients (We call them “Neuromuscular Re-Educative Exercises” at my clinic) even re-trains their mind-muscles for maximum, long-term results.

Vibration therapy
In one animal study (published in the October 2001 issue of The FASEB Journal), mere ten minutes per day of vibration therapy promoted near-normal rates of bone formation in rats. Consequently, this is a technique that I use intensively at my clinic.

State of the art medical devices
There are several state-of-the-art medical devices that I use at my clinic, namely:

 

Meditrac & Vertetrac

This is a huge improvement over the traditional traction devices devised by Dr. L. Stabholz and Dr. A. Grober. These doctors found that applying differential traction to patients with an antalgic lean (Sciatic Scoliosis) helped in restoring normal upright stance and decreasing muscle spasm, often leading to full recovery. Meditrac & Vertetrac are now extensively used in the patient’s rehabilitation process and accelerating blood flow to the tissues and intervertebral discs at my clinic.

 

Shockwave & Vibration Therapy

Shock Wave Therapy or ESWT implies the application of high-intensity ultrasonic acoustic radiation for the treatment of certain musculo-skeletal disorders. The machine focuses high energy sound waves on the injury through a protective pad that breaks down scar tissue and calcifications in the area, resulting in structural changes in the tissue, stimulation of bone growth, regeneration of the lost tissue and calcium absorption by the body, all of which are great for a full or partial recovery from scoliosis.

 

Non-Surgical Spinal Decompression

This FDA cleared technology relieves pain by enlarging the space between the discs. The treatment has been found to be remarkably effective in severe cases of herniation, degeneration, arthritis, stenosis and pressure on the nerve root. According to a clinical study performed by the Orthopedic Technological Review in 2004, 86% of all cases experienced spinal pain relief with disc decompression.

What are you waiting for?
Treat your scoliosis before it’s too late, i.e., before you cross 30 degrees of spinal curvature. Fix it before the problem spirals out of control. With timely intervention, we are able to reduce the curve to an ideal 5 degrees or less, thus defeating the disease rather than taming it.
The only thing to be borne in mind is that while surgery is usually over in a day or two at the hospital followed by subsequent rehabilitation, my program requires a lot more consistent effort, dedication and time. The advantage is that its significantly cheaper and safer than surgery.

Just think about it. Over 650,000 surgical procedures are performed annually for back pain in the United States that cost in excess of $20 billion per annum. “Can this money not be put to some better use,” questions Dr. Gunnar Andersson, former chairman of the department of Orthopedics at Rush. Dr Andersson and his team have found that often there is no link between people's health care expenditures and their health outcomes. This means that we often spend money on surgeries that are not required.

Don’t be part of that depressing statistic. Come and book your appointment with Dr Lau, today.

Surgery Vs Non-Surgical Scoliosis Correction

 

Spinal Correction Program

Surgery

Time

3 weeks for six months (minimum)

One day + One year rehabilitation

Risks

Low

High

Side effects

Pain free

Highly possible

Commitment

Full

Minimal

Results

Unlimited possibility

50% reduction

Costs

Comparable to a price of a brace!

$20,000 - $120,000
figures given by American Academy of Orthopaedic Surgeons

G. T.C. Wong, V. M.Y. Yuen, B. F.M. Chow, and M. G. Irwin, Persistent pain in patients following scoliosis surgery, Eur Spine J. 2007 October; 16(10): 1551–1556.

DISCLAIMER This Website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. This information is not provided in the course of a professional relationship between a health care provider and a patient. It is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. Do not disregard professional medical advice or delay in seeking it because of something you have read on this website.The provision of access to other external websites is solely for your convenience and Orchard Clinic is not responsible for the availability, accuracy or content of these external sites. Your access of any linked web site shall be at your sole risk. Orchard Clinic shall not be responsible for any damage or loss to you arising from or in connection with your use of such web sites. The entire contents of this website are based upon the opinions of Dr. Lau, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. Any reliance by you on the information contained in this website shall be at your own risk.

Nutrition


As most patients are well aware, good nutrition and a balanced diet are important components of overall health. What may surprise people with back problems is that diet, nutrition and maintaining a healthy weight also play a major role in the back - including preventing many problems and healing from injuries. The bones, muscles and other structures in the spine need good nutrition and vitamins so that they are strong enough to support the body and to perform their other functions. Using these nutritional guidelines, patients can integrate back-friendly vitamins and nutrients into their diets.

Learn top healing foods
Foods important for spinal development
Supplements that prevent spinal degeneration
Important vitamins that most kids and adults with spinal problems are important

Scoliosis has been induced in a variety of animals through the creation of nutritional deficits and imbalances. Not surprisingly, many of the nutritional imbalances linked to scoliosis in animals such as deficits of manganese, vitamin B6, and copper have all also been implicated as factors in osteoporosis in humans. As noted above, research shows there are strong links between scoliosis and osteoporosis. Could nutritional deficiencies and diet play a role in scoliosis in humans? That seems quite likely.

Rehabilitative Exercise


It is imperative that a scoliosis suffer gets treated from a trained chiropractor with good knowledge in treating scoliosis. Too often and untrained manual therapist will try to "click and "crack" the spine to push it back into place. While this method works for a normal spine a person it wont for a scolioctic spine but may actually increase the Scoliosis.

Can Chiropractic Care Help? Article

Orthotics


Orthotics (orthoses) are specially-prepared foot supports. These anatomically molded devices, worn under the heel and arch of your foot to correct skeletal anomalies, do more than "support" your feet. They actually realign them to a natural, "neutral" position to relieve foot, let and back stress, increase endurance, restore critical balance, improve sports performance, alleviate foot fatigue and prevent a wide range of foot problems. Foot alignment is particularly important as it affects spinal alignment due to leg length diffferences and imbalances such as flat foot that can lead to deformities in the spine. At Spinal Correction Centre we use 3D computerised foot scan to accurately custom make your orthodics.

Posture & Body Balance


While U.S. medical doctors may widely accept the premise

that exercise does not have a place in scoliosis treatment, this does not mean it is true. Being widely accepted and being true do not mean the same thing. What is important to ask is, is their belief based on common medical dogma, or on actual scientific studies? When looking through the PubMed database at the website for The National Institute of Health, I found quite a few studies showing positive benefits from exercise for scoliosis patients.

Below are some interesting papers on scoliosis and exercisetreatment. Note that these papers are based on actual scoliosis research --not just on common medical dogma. Sports activities are a recommended treatment for scoliosis in Croatia. Greater occurrences of scoliosis were observed in children with limited physical activity. Small cage size, which reduced the amount of space the animals had to move around in, caused deformation of the vertebral column in rabbits. Inactivity is a known cause of low bone densities, which, as noted above, are also associated with scoliosis in human studies.

Researchers from The Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand, reported on a case of a young scoliotic boy with progressive juvenile idiopathic scoliosis. They found that there was a rapid improvement in this child's spinal status achieved by physiological traction and specifically designed exercises. Exercise therapy has been used for scoliosis treatment at a back clinic in Germany with positive results.

"In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment. Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated."

(Emphasis added) From Conservative treatment of idiopathic scoliosis with physical therapy and orthoses by HR Weiss, Katharina-Schroth-Klinik. Orthopade 2003 Feb;32(2):146-56 A paper from researchers in Turkey published in the Saudi Medical Journal on the efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis found that after 6 weeks, 6 months and one year, of therapy, all patients had an an increase in muscle strength and recovery of the postural defects. The researchers concluded that the Schroth technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.

Physiatrists in Finland at Helsinki University Central Hospital, found pelvic asymmetry to be an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms. They report symptoms as improving with conservative, nonsurgical, simple and safe treatment.

A study of 19 patients by a group of chiropractors, found that the combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. It is interesting to note that one of the methods the chiropractors used to treat the patients was traction, a treatment that was popular for spinal curvature in the early 1900's.

EMS Electronic Muscle Stimulators


EMS is a useful tool for prevention or retardation of muscle spasm, muscle re-education, maintaining and increasing the range of motion, and increasing local blood circulation.

- Re-educates spinal stabiliser muscles
- Reduces muscle tension
- Balances spinal dynamics
- Improves blood circulation
- Increases healing

Shockwave Therapy


Shock Wave Therapy or ESWT is a type of technology for the treatment of musculo-skeletal conditions by application of high-intensity ultrasonic acoustic radiation. High energy sound waves are created and focused on the injury using a special pad. Shock waves are repeatedly applied to the injury area, and will break down scar tissue and calcifications in the area, which in chronic cases the body is unable to repair itself. The following processes can be initiated by shockwave therapy:

- structural changes on the tissue
- stimulation of bone growth
- stimulation of the regenerative process of the tissue
- structural changes in the calcium deposit followed by
reabsorption of the calcium by the body

Interferential


Interferential is an electical stimulation machine operating at very high frequencies, approximately 4000 Hz. These higher frequencies significantly lowers your skin resistance which allows penetration deep into the tissue and nerves whilst the sensation remains at a very comfortable level. Interferential pain relief capabilities are much higher and therefore more beneficial for people that live with Chronic Pain.

- Pain Relief
- Bone fractures
- Sports injuries
- Joint injury
- Cumulative trauma Disorders
- Migraines & Tension headache

Vibration Therapy


Standing on a vibrating platform causes muscles to respond involuntary with each vibration.

500 vibrations=500 muscle responses
2000 vibrations=2000 muscle responses

Vibration Therapy for Scoliosis
» Allows for greater flexibility
» Advances muscle response
» Enhances circulation
» Increases range of motion
» Helps prevent injury
» Amplifies metabolism
» Promotes bone mineral density
» Relaxes muscles
» Reduces strain on tendons
» Quicker recovery time
» Muscular re-education

How vibration works
We already know that the body adapts to the stress we put on it, and vibration adds to more variables for our bodies to adapt to. Because of the involuntary muscle contractions we are actually exercising without doing anything when placing part of our body on a vibration platform. If we exercise while on that platform our result will increase tremendously. When you place any part of your body on a vibration platform the muscles, which are vibrating, react to this stimulus, and produce an involuntary muscle contraction. These contractions set into play a series of events.

» This mechanical stimulus produces a stretch reflex which, depending on the selected frequency, results in muscles contracting 10 to 60 times per second, or 1000 to 3600 times per minute.
» Vibration training increases the production of regenerative and repair hormones, improves blood circulation, strengthens bone tissue, improves lymph drainage and increases basal metabolic rate.

This results in more strength, more speed, more stamina, rapid recovery of muscles and tissue, increased flexibility, mobility and coordination, improved collagen production, and fat reduction. Many of the leading experts in the health and fitness industry feel that vibration training is going to change every thing we do in rehabilitation and performance training.

Non-Surgical Spinal Decompression


Why Spinal Disc Decompression Works:

This FDA cleared technology relieves pain by enlarging the space between the discs. The negative pressure of decompression releases pressure that builds on to the disc and nerves, allowing the herniated and bulging disc to eventually go back into normal position. Decompression is the only treatment that is truly most effective for severe cases of herniation, degeneration, arthritis, stenosis and pressure on the nerve root. According to a clinical study performed by the Orthopedic Technological Review in 2004, said that 86% of all cases experienced spinal pain relief with disc decompression.

Who can benefit from using Disc Decompression Therapy?
  1. Nerve Compression
  2. Lumbar Disorders/Low Back Pain
  3. Sciatic Neuralgia
  4. Herniated Discs/Bulging Disc
  5. Degenerative Discs
  6. Spinal Arthritis
  7. Degenerative Joint Disease
  8. Acute Low Back Pain
  9. Post-Surgical Low Back Pain/ Failed Back Surgery
What Result I Expect?

Many patients with lower back syndromes may experience pain relief as early as the third treatment session. Comparison of pre-treatment MRI’s with post-treatment MRI’s has shown a 50% reduction in the size and extent of herniation. In clinical studies, 86% of patients reported relief of back pain with the our system. Within the past five years, some private practice clinicians have reported success rates as high as 90%.

More about Discs
In order to help you understand a little more about spinal discs here are two main facts about discs:

• First fact is discs do NOT have a direct blood supply. There are no arteries that feed the disc with oxygen and nutrients. Disc must therefore receive their oxygen and nutrients from a different source. Normal, healthy discs are "fed" and oxygenated by the constant recycling of the disc fluid that occurs within normal spinal movement. This movement of the disc "sucks" in fluid filled with oxygen and nutrients and "pumps out" waste fluid. This process of fluid diffusion is greatly affected by internal disc pressure (intradiscal pressure).

• The discs are always under constant pressure. They are designed to absorb shock and maintain spinal flexibility by acting as cushions during body movement. The discs act similar to shock absorbers in a car. Car shock absorbers maintain a constant pressure to "push back" against the weight and movement of the car. Discs act in a similar fashion. The pressure within the discs pushes the bones of the spine apart preventing them from crashing into one another during activities like running and jumping. Unfortunately, this constant internal disc pressure also pushes the fluid out of the disc consistently every day. This makes it difficult for the body to "suck" in new, healthy disc fluid with its much-needed oxygen and nutrients. These two factors make it difficult for the body to maintain thick, plump, healthy discs making it vulnerable to conditions such as bulging and protruding discs, degenerative disc disease, and sciatica.

Surgery


Surgery for scoliosis is only recommended for patients with curves that are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. The main objective of scoliosis surgery is to fuse the spine so that the curve will not continue to progress into adulthood.

Only more severe curvatures (greater than 50 degrees) are likely to progress in adulthood. If a curve is allowed to progress to 70 - 90 degrees, it will not only result in a verydisfiguring deformity, but will start to result in cardiopulmonary compromise. This happens because the curve in the spine rotates the chest and closes down the space available for the lungs and heart. Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together (See Figure 3). Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.

Example of Surgery:

Scoliosis surgery from the back
- This approach to scoliosis surgery is done through a long incision on the back of the spine (the incision goes the entire length of the thoracic spine)
- After making the incision, the muscles are then stripped up off the spine to allow the surgeon access to the bony elements in the spine
- The spine is then instrumented (screws are inserted) and the rods are used to reduce the amount of the curvature
- Bone is then added (either the patient's own bone, taken from the patient's hip, or cadaver bone), which in turn incites a reaction that results in the spine fusing together.
- This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.

How Effective is Bracing


Opinions Vary About Bracing for Scoliosis Posted May 10th, 2007 by Matt in Children's Orthopedics

What happens to children with scoliosis (curvature of the spine) if they aren't treated?
Do they stay the same, get better,or get worse?
Bracing is the standard treatment for curves that measure more than 45 degrees.

But what would happen to these children if they didn't wear a brace? Can a study be done to compare children with braces to children without bracing? So far this hasn't been done because it isn't ethical. Not bracing a child with scoliosis is the same as denying that child treatment.

In this study, researchers survey more than 50 pediatric orthopedic surgeons on this topic. Case examples of possiblepatients were presented. The surgeons were given choices about different ways to treat each one. They were asked to guess (estimate) how many patients could be treated successfully with and without bracing.

The number of surgeons who responded to the survey was very low. The authors decided to put together an expert panel from those who did reply. Again, the surgeons were asked to give estimates on the success of treating scoliosis with and without bracing. They were given 12 different patient profiles to judge. There was general agreement that bracing works much better for girls before they start their first menstrual cycle (premenarchal). This opinion was the same for both small and large curves. The group agreed that large single or double major curves in postmenarchal girls aren't as likely to respond to bracing.

There was a wide range of opinion over the success of bracing. Only about one-third of the group agreed about the benefits of bracing. The authors suggest that studies to compare results with and without bracing can be justified. They say it's not right for patients to suffer the cost or thediscomfort for a treatment that hasn't really been proven beneficial.Two-thirds of the expert panel agreed with this conclusion.

How Effective is Current Treatment




"In summary, statements claiming that scoliosis cannot be stabilized or reversed without bracing or surgery are not, and never have been, supported by scientific data. On the contrary, as detailed in this book, long-standing basic and clinical research results in documented in reputable medical journals are consistent with the hypothesis that scoliosis can be reduced if not eliminated using nonsurgical approaches."

Excerpt from Scoliosis and the Human Spine, by Martha C.

Hawes, PhD. Found Here Surgery and Braces: Have they been proven safe and effective?

The U.S. government has presented papers on scoliosis screening that includes information on the effectiveness, benefits and risks of scoliosis braces and scoliosis surgery: U.S. Preventive Services Task Force (USPSTF) Guidelines: Screening for Adolescent Idiopathic Scoliosis . Please note this is an older study, but you can get a brief evidence update from 2004 here. Significant findings from the USPSTF were, "The USPSTF found fair evidence that treatment of adolescents with idiopathic scoliosis detected through screening leads to moderate harms, including unnecessary brace wear and unnecessary referral for specialty care. As a result, the USPSTF concluded that the harms of screening adolescents for idiopathic scoliosis exceed the potential benefits.*

A landmark 2003 study from Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, published in the Journal of American Medicine (JAMA), found that "Untreated adults with LIS** are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns." For more information read the abstract, "Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients".

CBS News reported on their web site that the results of this study meant that "Many adolescents diagnosed with spine curvatures can skip braces, surgery or other treatments without developing debilitating physical impairments later in life, a 50-year study suggests."

Risk of Surgery


Complication rates are high (nearly 10%) with any of these procedures, including the standard Harrington method and the newer Cotrel-Dubousset procedure.

Complications for all procedures include allergic reactions to anesthesia and the following:

Bleeding
Standard procedures increase the risk for major blood loss during the procedure. Patients are encouraged to donate blood before the operation for use in possible transfusions. Children sometimes require more than one transfusion following surgery. Researchers are investigating various methods for reducing the need for transfusions.

Infection
Infection is always a risk with any operation. One study reported changes in the immune system for about 3 weeks after surgery, which indicated a greater risk for infection. Researchers recommended being very vigilant for signs of infection, including in the pancreas and urinary tract. Doctors also recommend antibiotics, given by injection for 2 - 5 days after surgery and by mouth for 1 - 2 weeks longer.

Nerve Damage
Any time surgery is done on the spine, there is some risk of injuring the spinal cord, which can lead to nerve damage. The nerves in each area of the spinal cord connect to specific parts of your body. This is why damage to the spinal cord cancause paralysis in certain areas and not others' + ';' + ' it depends on which spinal nerves are affected.

Spinal Cord Injury
Operations on the spine have some risk of injuring the spinal cord or spinal nerves. This can occur from instruments usedduring surgery, from swelling, or from scar formation after surgery. Damage to the spinal cord can cause paralysis in certain areas and not others. Injured nerves can cause pain,numbness, or weakness in the area supplied by the nerve.

Pseudoarthrosis
If the fusion fails to heal, pseudoarthrosis, a painful condition in which a false joint develops at the site, may develop. In one study, teenagers who smoked and heavier adolescents (over 154 pounds) who had hyperkyphosis (hunchback) were at higher risk for this complication. The anterior approach may pose a higher risk for pseudoarthrosis. One study reported that pseudoarthrosis may be undiagnosed, and rates may average 20% after surgery, therefore acting as a major contributor to post-surgery pain.

Implant ComplicationsMetal screws, plates, and rods are used in many different types of spinal operations as part of the procedure to hold the vertebrae in alignment while the surgery heals. These metal devices are called "hardware". Once the bone heals, the hardware is usually not doing much of anything. Sometimes the hardware can either break or move from the correct position before the surgery is completely healed. This is called a hardware fracture. If this occurs it may require a second operation to either remove or replace the hardware.

Disk Degeneration and Low Back Pain Fusion in the lumbar area produces great stress on the lower back and eventually can cause disk degeneration. Loss of trunk mobility, balance, and muscle strength from surgical treatments can also cause lower back pain and chronic problems in future years. Patients who are surgically treated with fusion techniques lose flexibility; their back muscles may be weakened if they were injured during surgery. In most cases, however, the consequences are mild to moderate.

Lung Function Some patients may develop serious lung problems after surgery. These complications are highest in children whose scoliosis is due to neuromuscular problems, such as spina bifida, cerebral palsy, or muscular dystrophy. Lung problems can occur up to 1 week after surgery. Lung function may not become completely normal until 1- 2 months after surgery. Other Complications

Other problems can include, but are not limited to, the following:
Hooks dislodging or a fused vertebra fracturing Gallstones Pancreatitis (inflammation of the pancreas). Among adolescents, this complication tends to occur more often among those who are older or who have a lower body mass index. Intestinal obstruction

Bracing


Currently, the spine medical community advocates bracing as the only non-surgical treatment for idiopathic scoliosis. The objective of bracing treatment is to prevent the curve from progressing as the child grows, and studies have shown bracing is effective in stopping the progression of the majority of adolescent scoliotic curves.

There are a number of bracing options, and the physician willrecommend a particular back brace and bracing schedule based on factors such as the location of the child's curve and degree of curvature. Compliance with wearing the back brace as prescribed is clearly vital to the success of bracing treatment.

Unfortunately, even with appropriate bracing, some spinal curves will continue to progress. Early on it is very difficult to tell which curves will be aggressive and continue to progress, and which curves will not continue to progress.

The brace needs to be worn 23 hours each day until the doctor determines that the patient has reached skeletal maturity. At that point, you might be switched to wearing the brace at night only.

Risk of Bracing


Conventional brace therapy has several significant drawbacks; because the brace stabilizes the spine by exerting pressure on the chest at critical points, it must envelop the trunk, and to do so, it must be bulky and uncomfortable. In stabilizing the spine, the brace restricts truncal motion, causing atrophy and weakness of chest and spinal musculature. As an end result, the spine becomes limited in its flexibility and more prone to injury when the brace is taken off. Finally, the constant pressure of the brace, in some cases, may cause permanent deformation of the rib cage or the soft tissues directly under the pressure points.