Mr Robert Lee, Consultant Spinal Surgeon at the Royal National Orthopaedic Hospital in Stanmore answers questions about adult scoliosis.
How common is scoliosis?
Scoliosis is said to affect one in six people, but most people don’t know they have it because it is so mild. There are different types of scoliosis—infantile, juvenile, adolescent, neuromuscular and adult degenerative scoliosis. Essentially, the difference is when it presents—i.e. were you born with it or did it develop during the pubertal growth spurt. Scoliosis is not hereditary unless you have an inherited genetic condition where scoliosis is one of the clinical signs.
Adult scoliosis is very different. It occurs when the intervertebral discs degenerate, leading to the spine becoming deformed. The best analogy is to think of the spine as a brick wall where the bones are bricks and the discs are the mortar. In adult scoliosis, the mortar crumbles and the wall becomes deformed. Adult scoliosis is not hereditary.
Does everyone with adult scoliosis require surgery?
Not everyone with adult scoliosis needs surgery. In fact most people don’t know they have it and find out only when they see their GP with severe back or leg pain or report problems with standing straight. Of all the symptoms, it is the nerve entrapment due to the disc degeneration that is the most painful and leads to surgery.
How long does surgery take?
This varies from less than an hour to long, complex two-stage procedures lasting seven to eight hours each. It all depends on how many discs have gone and how severe the deformity is. It also depends on the patient and if the patient is very obese. In this case, the operation can take twice as long and the risk of incurring complications is higher.
How long will it take to recover from scoliosis surgery?
This depends on what surgery is required and can vary between four weeks to a year in the more complex reconstructions. Some patients only need one level fused whereas others need their whole spine fused. Specialist units such as the Royal National Orthopaedic Hospital in Stanmore use minimally invasive techniques to speed up recovery.
Does scoliosis surgery leave big scars?
Yes, it can leave big scars if the whole spine is fused. Single or two-level surgery leaves much smaller scars and minimally invasive techniques are used by some specialist surgeons in order to make these scars as small as possible.
Does everyone get taller after scoliosis surgery?
Generally, people are taller after scoliosis surgery as you are straightening out the s-shaped curve. In adult scoliosis, the other problem is that of being stooped forward because of the loss of the curvature in the lower back. After surgery, surgeons try and correct this to make patients stand taller.
How long after surgery will physiotherapy be necessary?
Almost straight away—it’s important to get moving as soon as possible to prevent postoperative complications such as clots in the leg. The duration of physiotherapy varies depending on how big the surgery is and can be anything from six weeks to three months. It is important to carry on doing the exercises you have been taught even after being discharged from the physiotherapist.
Are there any measures you can take to avoid surgery in adult scoliosis?
Adult scoliosis develops due to disc degeneration and it is a known fact that smoking causes the discs to degenerate faster—stopping smoking helps. Also, if you need surgery, then some surgeons refuse to operate if the patient still smokes as it halves the rate of fusion. Other preventative measures include working on your core strength—pilates, yoga and swimming. Keeping you weight down and keeping active is also important.
What happens if scoliosis is left untreated?
Most times, adult scoliosis is mild and does not need treatment. Also, it often doesn’t progress rapidly. However, in severe cases, it can lead to nerve compression which results in severe pain down the leg (sciatica). Also, if the discs degenerate critically, you can end up being badly stooped forward.
How do I know if I have adult scoliosis?
Sometimes you can tell just by looking in the mirror. The only definitive way is to be examined properly by a doctor or a specialist nurse and to have a whole spine X-ray to visualise the bones themselves.