Guidelines for Scoliosis Treatment

Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. When a person with scoliosis is viewed from the front or back, the spine appears to be curved. When diagnosed with this condition, individuals should take scoliosis treatment into account. There are some guidelines for scoliosis treatment and patients should know about them.

The scoliosis treatments are various and the decision to begin treatment is always made on individual basis. Some factors will be considered.

    

1.Sex. When the curve is mild, the possibility of scoliosis progressing further is almost the same as boys. But if it is moderate or severe, girls have a much higher risk of progression than do boys.


    2. Severity of curve. Larger curves are more likely to worsen with time. Mild scoliosis carries a significant risk of progression (up to 22%). Once the scoliosis passes 20°, risk of progression more than triples to 68%. Severe Scoliosis carries a 90% risk of progression. It is an important factor during the decision of scoliosis treatment.


    3. Curve pattern. There are two main types of curve pattern, S-shaped and C-shaped. S-shaped curves tend to worsen more often than do C-shaped curves.


    4. Location of curve. Generally speaking curves located in the center section of the spine worsen more often than do curves in the upper or lower sections of the spine, that is cervical segment and lumbar vertebrae.


    5. Maturity. If the patients’ bones are mature, the risk of curve progression is lower than adolescents. That’s why brace is often advised for adolescent scoliosis instead of adult scoliosis.
    

6. Age. The earlier patients diagnosed with scoliosis first, the more likely scoliosis develops.


After analyzing the likely of scoliosis progressing further, patients would have an idea of their curves. Actually adolescents should have treatment as early as possible as it may progress. They can think about physiotherapy even the curve is over 40 degrees for some physiotherapy is effective. Adults often take scoliosis surgery, but if the curve is small and it develops very slowly, they may not need to take scoliosis treatment.



Source : NON  SURGICAL SCOLIOSIS , 2nd Jan 2013

Spinal Fusion for Adult Scoliosis: What Are Survival Rates?

An article recently published in The Spine Journal found that survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

The study examined 59 patients 21 years or older that underwent primary surgery for idiopathic or degenerative curves and were followed for minimum of two years postoperatively. Survival rate at three years was 73.4 percent and 64 percent at five years. At 10 years postoperatively, the survival rate was 60.9 percent.

Over the entire follow-up period, 35.6 percent of patients underwent revision surgery, with the most common reasons for the revision being:

•    Painful/prominent implants
•    Adjacent segment disease
•    Infection

A higher revision rate was found among American Society of Anesthesiologists Type II patients and double surgical approach patients.

Source : Becker's Spine Review , 16th Dec 2013 

Spine and Orthopedic Devices and Implants

Here are seven things for spine surgeons to know...

Budget bill would stall Medicare pay cut, raise physician pay 0.5%.


The House of Representatives passed a bipartisan budget last week that would impact Medicare payment cuts to physicians if passed by the Senate. Under the sustainable growth rate, Medicare announced it would cut physician pay 20.1 percent in 2014. The budget would postpone that pay cut rate until April 1, 2014 and give physicians a 0.5 percent raise during the interim period.

AAOS supports SGR repeal efforts.


The American Academy of Orthopaedic Surgeons supports the recent legislative efforts to repeal the sustainable growth rate. AAOS encouraged Congress to continue to repeal and replace the SGR formula as soon as possible.

Orthopedist compensation decreased by 10% from 2011 to 2012.


Compensation decreased by 10 percent or more than 10 percent for orthopedists from 2011 to 2012. Of the respondents, about 20 percent saw a 10 percent or more decrease and 32 percent saw compensation remain the same.

Spinal fusion survival rates for adult scoliosis as high as 89.8%.


An article recently published in The Spine Journal found the survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

Survival rate at three years was 73.4 percent and 64 percent at five years. Over the entire follow-up period, 35.6 percent of patients underwent revision surgery.

FDA committee called for Class 3 device designation on spinal sphere devices.


After meeting recently, a U.S. Food and Drug Administration committee agreed spinal sphere devices should be classified as Class 3 devices, which require premarket approval.


NuVasive announced US launch of ALIF column realignment device.


San Diego-based NuVasive's anterior column realignment device for anterior lumbar interbody fusion launched in the U.S. The ALIF ACR is tasked with correcting the sagittal plane imbalance that advanced degeneration can cause.

Dr. Richard Wohns among first to perform two-level cervical disc replacement using Mobi-C.


Richard Wohns, MD, JD, MBA, performed the first two-level cervical artificial disc replacement surgery in the Northwest and one of the first in the nation, using Mobi-C Cervical Disc Prosthesis.


Source : Becker's Spine Review , 17th Dec 2013

UI researchers: Bracing is effective in adolescents with idiopathic scoliosis

Longer daily wear is best to avoid surgery

A multi-center study led by University of Iowa researchers to determine whether wearing back braces would prevent the need for spinal correction surgery in children with adolescent idiopathic scoliosis (AIS) was cut short when early results were overwhelmingly in favor of bracing.

The study was published in the New England Journal of Medicine today (Sept. 19. 2013).

Stuart Weinstein, MD, Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery and Professor of Pediatrics at University of Iowa Children’s Hospital, and Lori Dolan, PhD, a research scientist in The Department of Orthopaedics and Rehabilitation at the UI Carver College of Medicine, led a study team that set out to compare the risk of curve progression in patients with AIS who wore a brace with patients who did not. The study team, from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), recruited patients who were at risk for continued worsening of their spinal curves based on age, skeletal immaturity and curve severity.

AIS is a curvature of the spine with no clear underlying cause. In mild cases, monitoring over time by a physician may be all that is needed. However, in more severe cases – especially when the child is still growing – the use of a brace, or even surgery, may be recommended. Left untreated, more serious curves can be painful and deforming.

Weinstein has been working with scoliosis patients for nearly 40 years, and although bracing has been used as a treatment for curvature of the spine since 1948, he says there has always been some question as to whether it was truly an effective way to avoid surgery.

“The efficacy of bracing was never really proven,” he says. “I wasn’t sure if braces really worked or not, and I’ve treated thousands of patients.”

He says the literature about bracing “wasn’t convincing that it worked.” Additionally, he says, some patients still required surgery after wearing a brace.

For the study, investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and Feb 2011. Although the study began as a completely randomized clinical trial, the team eventually added a “preference cohort,” where patients and families could choose their own treatment. About 40 percent of study participants were randomly assigned to bracing or to close observation without bracing. The remaining participants made their own choice regarding bracing or observation.

Patients in the observation arm received no specific treatment, while those in the bracing arm were instructed to wear a brace for 18 hours per day. Treatment was considered to be unsuccessful when a curve progressed to 50 degrees or greater – a point at which surgery is typically recommended. Treatment was considered a success when the child reached the age of skeletal maturity without this degree of curve progression.

In January 2013, the trial was stopped early after finding that bracing significantly reduced the risk of curve progression and the need for surgery, and that more hours of brace wear was associated with higher success rates. Among both the randomized and preference cohorts, 72 percent in the bracing group, and 48 percent in the observation group achieved success. In addition, the results suggest that the more a patient wore the brace, the better the results; wearing a brace more than 13 hours per day was associated with success rates of 90 to 93 percent.

“This study definitely shows braces work and are effective in preventing the need for surgery,” Weinstein says. “Children who are at risk should be treated with a brace, and they should wear it at least 13 hours a day for it to be effective.”

According to the researchers, the findings are clinically relevant to patients for whom bracing would typically have been recommended. But until now, that recommendation had not been based on solid data. “This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – does bracing prevent the need for surgery? The answer is clearly ‘yes’,” Weinstein says.

The investigators also suggest that current bracing indications may be too broad, since 48 percent of patients in the observation group and 41 percent of patients in the bracing group who wore the brace infrequently also achieved success. “Further analysis will help us identify those AIS patients for whom bracing may be the most beneficial,” Weinstein concludes.

Source : Yotta Fire , 17th Dec 2013

British teenager overcomes extremely curved spine to become a model !

Zoe Blenkinsop, 19, undergoes seven hours of surgery and years of bullying to stand tall. She now strides down the catwalk at British shows.

Zoe Blenkinsop is now fashion model after undergoing drastic surgery to correct her severely curved spine and to remove a protruding lump.

A British teenager who was bullied as a child after an agonizing spine condition left her with a hunched back and a severe limp has had the last laugh  — after landing a job as a catwalk model.


Zoe Blenkinsop, 19, from North Shields, has suffered scoliosis since childhood and was bullied throughout school because she had a lump which protruded from her back where her spine curved.


She would spend hours practicing her poses and catwalk runs but struggled as her curved spine, which left her with a limp, shattered her confidence.


When she was diagnosed with the condition at age 11, doctors said they could perform an operation on her, but she would have to wait until she had finished growing.

An x-ray of Zoe Blenkinsop’s spine shows her drastically curved back. Seven hours of surgery corrected the deformity and the British teenager now commands the catwalk.

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And now, after undergoing a gruelling seven-hour surgery, she is finally walking tall.


"I was always so conscious about my back because there was such a huge lump sticking out from it," she said.


"I never allowed anyone to take pictures of me because I didn't want them to see it. In PE (physical education) I would hide in a corner to get changed so that no one saw it as I was already being bullied.

"When I was told I could have the operation I was so happy, but I knew I had to wait a long time for it."

Zoe Blenkinsop, 19, after back surgery to correct her severe scoliosis. She is now a fashion model. 

 

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In July 2011 Zoe was finally able to go ahead with the operation and was in surgery for seven hours while they fitted metal rods to straighten her spine.


It took her a year to recover from the major surgery and she had to teach herself how to walk, sit and stand all over again.


Zoe is now able to live her dream of modelling and is no longer worried about what others think of her.


"I used to look at everyone else in school and think about when I would be normal like them," she said.

This x-ray, taken after Zoe Blenkinsop’s operation, shows the metal rods implanted to straighten her spine.


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"The pain would be horrible some days and I wasn't able to sit or stand for a long time. The only way to ease it was to lie down, which was pretty embarrassing. I felt like an old lady."


"Recovering from the operation took a long time," she said, "and it was really hard."


Scoliosis causes the spine to curve sideways and impacts about four percent of the population.


If left untreated it can lead to fatal heart and lung problems and damage mobility.


Treatment for the condition is usually a major operation which is very risky but is the most frequently used method.


Blenkinsop had her first taste of modelling success when she stepped on to the catwalk for Newcastle Fashion Week.


"Modelling has always been a dream of mine, but I never thought it was possible," she said. "I knew that standing and posing for shoots would be impossible and I would have been far too scared to walk down the catwalk with my limp."



Source : Daily News , 22nd Nov 2013

Researchers identify mechanism of brachial plexus injury in scoliosis surgery

Researchers in this study retrospectively analyzed pediatric patients who received distraction-based growing implants to treat early-onset scoliosis and identified the mechanism of injury for 4 patients with an intraoperative brachial plexus injury.

“Patients with Sprengel deformity appear to be at increased risk for brachial plexus injury when undergoing distraction-based spine instrumentation with rib anchors. Injury to the brachial plexus can occur with scapular elevation alone, presumably by direct compression of the superior end of the scapula on the brachial plexus,” Elizabeth R.A. Joiner, BS, and colleagues wrote in the study abstract. “Brachial plexus injuries may be ‘hidden’ during monitoring of an arm in shoulder abduction but symptomatic with shoulder adduction, as the brachial plexus is draped over the elevated first rib.”

Joiner and colleagues performed a single-center review of 41 pediatric patients who underwent scoliosis correction surgery with distraction-based growing implants with rib anchors between 2001 and 2011.

They found three mechanisms of injury associated with brachial plexus injuries that occurred 4 patients, which were “injury of the brachial plexus by the first rib being pushed superiorly by rib-anchored growing instrumentation, direct injury to the brachial plexus by the superior pole of the retracted scapula, and injury of the brachial plexus when the scapula was moved inferiorly during Sprengel deformity reconstruction,” according to the abstract. The last two mechanisms of injury were independent of spinal instrumentation, the researchers noted.

Two patients with a brachial plexus injury had neurological symptoms or neuromonitoring signal changes with their arm in an adducted position, but not when it was abducted, and all the patients recovered completely, according to the abstract.

Disclosure: One of the authors (Skaggs) received a consulting fee or honorarium from Biomet, Medtronic and BeachBody LLC.


Source : Healio , 21st Nov 2013

'I was terrified I'd become a hunchback': Teenager, 18, overcomes agonising spine condition to become a model

Leanne Roberts, 18, has scoliosis which makes her spine S-shaped

It caused her severe pain every time she moved and damaged her confidence

Doctors said she'd need a risky 12-hour operation to straighten her spine

Turned down the surgery as she thought it would end her modelling career

Instead, she found relief in exercises specially designed to strengthen the muscles around her spine

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A teenager who was terrified of becoming ‘a hunchback’ because of her misshapen spine has achieved her dream of becoming a model.


Leanne Roberts, 18, suffers from severe scoliosis which makes her spine curved.
The schoolgirl would spend hours in front of a mirror attempting to improve her posture.

Leanne Roberts, 18, has scoliosis which causes her spine to bend in an S-shape. It caused her severe pain when she moved and she feared she would end up in a wheelchair.

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When she was diagnosed with the condition at 16, doctors told her she would need a 12-hour operation and she feared it would end her dreams of becoming a successful model.

Scoliosis causes the spine to excessively curve sideways. The condition affects around four per cent of the population and if left untreated it can lead to fatal heart and lung problems.

Current treatment techniques centre on having major operations, which are risky procedures involving metal rods being inserted either side of the spine.

Doctors told Leanne that she would need a risky 12-hour operation to correct the curvature in her spine (pictured) but she refused to have the surgery as she thought it would end her chances of being a model..


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Instead, she turned to a non-surgical treatment to improve her condition, and has stunned medics with her remarkable progress.


Leanne of Barnsley, South Yorkshire, said: ‘It was awful how much time I would spend crying and I was terrified of what would happen to me when I was first diagnosed.


‘I was paranoid I would end up looking awful and would end up in a wheelchair.’
Leanne, who often modelled in fashion catalogues, has a double S-shaped curved spine.



Leanne has now found relief from the pain in her back by doing exercises to strengthen the muscles around her spine


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She first noticed aching pains when she was 14, but put them down to growing pains.
It was only when she started to suffer agonising sharp pains during photo shoots that she mentioned it to her mother and went to see her GP.


She was told by a consultant she would need surgery but instead discovered a clinic called Scoliosis SOS on the internet. The idea is that various exercises can strengthen the muscles surrounding the spine, stabilising the condition.


Leanne said: ‘I was ecstatic and I couldn’t wait to start the treatment. I think everyone should consider exercise before putting themselves through a risky operation.


‘I could feel the difference in my back after the first few days, and I could see the difference.


‘As long as I keep up with the exercises I shouldn’t suffer from pain and my scoliosis should stabilise. I feel like I am back in control again.’


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'I lost interest in everything and I had no quality of life at all. I had gone from being really confident in my body to wanting to hide away at every opportunity. As long as I keep up with the exercises I shouldn’t suffer from pain and my scoliosis should stabilise. I feel like I am back in control again'

- Leanne Roberts 

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The condition is likely to get worse, but Leanne has thrown herself back into modelling regardless.


She said: ‘I am so happy now - it's remarkable how far I have come. I was in constant pain on a daily basis and my whole world had fallen apart.

‘I lost interest in everything and I had no quality of life at all. I had gone from being really confident in my body to wanting to hide away at every opportunity.

‘I feel I can now finally look forward.’


A spokesman for Scoliosis SOS said: ‘Leanne decided our treatment could not do any harm and if it worked it could change her life.


‘Within weeks of being on the course, Leanne’s condition dramatically improved. She was no longer lying awake at night with pain and her confidence soared.


‘Since completing her treatment, Leanne has returned home and has been able to shop and feel confident in her clothes again for the first time in months.


‘She has regained all of her passion for life and has bounced back to her normal, fit and sociable self. She has also re-started her modelling career and is very excited about what the future holds.’

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WHAT IS SCOLIOSIS AND WHAT ARE THE SIGNS OF THE CONDITION?

1.Scoliosis is the abnormal curvature of the spine in an S-shape.


2.Signs include a visible curve in the spine, one shoulder or hip being more prominent than the other, clothes not handing properly and back pain.


3.Pain usually only affects adults with the condition.


4.In most cases, the cause of the scoliosis is not known but it can be caused by cerebral palsy and muscular dystrophy.


5.In the UK, scoliosis affects three to four children could of every 1,000.

6.It is also thought that as many as 70 per cent of over 65s have some degree of scoliosis.


7.It is more common in women than in men.


8.Most children with the condition do not require treatment as it is mild and corrects itself as the child grows.



9.However, in severe cases the child may need to wear a back brace until they stop growing.


10.Occasionally, a child needs surgery to straighten their spine.

11.In adults, it is usually too late to treat the condition with a back brace or surgery so treatment revolves around reducing pain.

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Source: Mail Online ( Health ) , Via NHS Choices ; 4 Nov 2013