Idiopathic Scoliosis

Adolescents

Surgical Treatment

Front and side X-rays of a patient with adolescent idiopathic scoliosis in her thoracic spine. B: Post-surgical correction through a posterior approach using two rods and pedicle screws.

Figure 1: A) Front and side X-rays of a patient with adolescent idiopathic scoliosis in her
thoracic spine. B) Post-surgical correction through a posterior approach using two rods
and pedicle screws.

Surgical treatment is recommended for patients whose curves are greater than 45^o while still growing, or are continuing to progress greater than 45^o when growth stopped. The goal of surgical treatment is two-fold: first, to prevent curve progression and secondly to obtain some curve correction. Surgical treatment today utilizes metal implants that are attached to the spine, and then connected to a single rod or two rods. Implants are used to correct the spine and hold the spine in the corrected position until the instrumented segments fuse as one bone. The surgery can be performed from the back of the spine (posterior approach) (Figure 1) through a straight incision along the midline of the back or through the front of the spine (anterior approach) (Figure 2). Although there are advantages and disadvantages to both approaches, the posterior approach is utilized most often in the treatment of AIS and can be utilized for all curve types. The anterior approach is an option when a single thoracic curve or a single lumbar curve is being treated. Many factors go into the decision as to the surgical approach and your doctor will review the options and choose the best approach for you.

Following surgical treatment, no external bracing or casts are used. The hospital stay is generally between 3 and 6 days. The patient can perform regular daily activities and generally returns to school in 3-4 weeks. Depending on the activities of the patient, full participation is allowed between 3 and 6 months after surgery. Most children will not need pain medications 10-14 days after surgery.

A: Front and side X-rays of a patient with adolescent idiopathic scoliosis in her thoracic and lumbar spine. B: Post-operative xrays showing instrumentation placed via an anterior (side) approach.

Figure 2: A) Front and side X-rays of a patient with adolescent idiopathic scoliosis in her thoracic and lumbar spine. B) Post-operative xrays showing instrumentation placed via an anterior (side) approach.

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