Scoliosis - Treatment for Adult Scoliosis

Surgeons prefer to operate on adults under 50 years old, although surgery may be appropriate in some older people.

Standard Scoliosis Procedures in Adult Scoliosis. The procedures involve the following depending on whether the patient had been treated previously or not.

In patients who have not had previous treatment and who have degenerative lumbar scoliosis, the procedure is often a discectomy (removal of the diseased discs) followed by scoliosis procedures (instrumentation and fusion).
In patients with previously treated scoliosis, the only remedy is removal of the old instrumentation, extension of the fusion, and implementation of new instrumentation and bone grafts.

Surgical procedures in adult scoliosis are complex and are undertaken only after careful consideration and all nonsurgical methods have been used. Adults have a much higher risk than children for complications, including pneumonia, infections, poor wound healing, and persistent pain. In addition, procedures in adults often involve fusion in lumbar and sacral areas (the low back), which can cause a number of complications. Some experts believe that the risks of operations in this area nearly always outweigh any benefits in adults and should not be performed. Most studies on adults have also reported low success rate.

Others argue that without an operation, the back will become unstable and painful. In addition, most studies on adults report on procedures using the old Harrington instrumentation techniques. Advances in instrumentation are increasing success rates in adults.

In fact, in a 2002 study, for example, excellent results were obtained in adults who underwent anterior fusion and instrumentation. In a 2003 study of newer generation instrumentation, 87% of adult patients reported satisfaction. Unfortunately, few studies have been conducted on the best approach to this problem, which is increasing in numbers as women who had been surgically treated in childhood get older.

Wedge Osteotomy. In patients with mature spines, wedge osteotomy is being investigated as corrective surgery and as an alternative to braces. In this procedure, wedges of bone from the concave side of the curve. They then straighten the spine by closing the cut section. The patient needs to have a temporary rod in place and to wear a brace and restrict activity for about 12 weeks or until the bone has healed. The rod is removed and the spine is mobile. The safety and effectiveness of this procedure is being studied.