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Anne Asher

Adult Scoliosis Surgery

By October 5, 2010

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How often do adults over the age of 40 have surgery for scoliosis? Certainly not as often as adolescents and young adults.

We don't know a lot about how adults with scoliosis fare when they're given spinal fusions. Because of their age, many have health problems in addition to their scoliosis. And since their skeletons are fully matured at the time of surgery, their curves may be more rigid. So the complication and success rate for spinal fusion given for adult scoliosis is most likely very different than those for children and young adults.

A new study published in the September 15 issue of Spine looked at 35 people over the age of 40 who had the scoliosis surgery. The study sought to find out the rate of complications and how much straightening was done (in degrees) during the surgery. The average age of the participants was 56.3. Most had more than one health problem.

The researchers found that in this small sample of scoliosis surgery patients, almost 50% experienced complications. (None of the complications affected the success of the surgery.) Although no deaths occurred, 26% of the complications were major. The average curve correction was 30.8 degrees.

Doctors generally begin suggesting surgery when they see that the curve(s) are 50 degrees.

Another study (funded by Medtronic) looked back at the records of 113 adult scoliosis surgery patients and found that about 0.08% participants endured significant problems from failed hardware. The pain and other symptoms didn't surface until about 3-4 years after the surgery. The other 104 surgery patients reported a successful surgery overall, while the 9 with hardware failure reported very poor outcomes overall.

From an interview with Dr. David B. Levine, Clinical Professor of Orthopedic Surgery at Cornell University Medical College, Nancy Schommer, science writer and author of Stopping Scoliosis told the National Scoliosis Foundation that your health is one risk factor for complications. She also reported that if you have two curves that need straightening, you'll need two surgeries, which increases the risk for complications as well.

If you are strongly opposed to having surgery, you may want to know if a targeted back exercise program can help you reverse the curves. Ms. Schommer reports, "exercise can help pain that may be associated with scoliosis; the best you can do is swimming the sidestroke and the backstroke. But exercise is not a treatment for scoliosis. It cannot stop a curve from progressing."

I'd love to tell you I disagree with her, but so far I haven't seen it.* For people well into their adult years, it's very difficult if not impossible to influence the fit of the bones and degree of curve with just exercise. Part of the reason may be that over time our bones go through degenerative changes. As the shape of the vertebrae morphs, getting the curves straight is more difficult. The change in shape affects way bones fit with adjacent bones, sort of wedging them snugly, albeit dysfunctionally, together. Once you're into adulthood, that pattern is pretty much set.

I do believe exercise can greatly contribute to pain management, and can significantly increase your abilities to do daily activities and sports. I've seen how it can help people with severe curves breathe and speak better. But reverse the direction and rotation of the bones? I wouldn't count on it. NOTE: If you're still not convinced, check out my *asterisk* text, below.

*For you forward thinking, pro-active types: I have heard and read anecdotal evidence of a few adults who have reversed their scoliosis using the Scroth Method. The Scroth Method is a complete system of physical therapy - exercises, brace wearing, lifestyle counseling - to address scoliosis.

Sources:

Bridwell, K. MD. et. al. Changes in Radiographic and Clinical Outcomes

With Primary Treatment Adult Spinal Deformity Surgeries From Two Years to Three- to Five-Years Follow-up. Spine:
15 September 2010 - Volume 35 - Issue 20 - pp 1849-1854
doi: 10.1097/BRS.0b013e3181efa06a http://journals.lww.com/spinejournal/Fulltext/2010/09150/Changes_in_Radiographic_and_Clinical_Outcomes_With.5.aspx

National Scoliosis Foundation. Adult Scoliosis by Nancy Schommer, author of Stopping Scoliosis Accessed: October 2010. http://www.scoliosis.org/resources/medicalupdates/adultscoliosis.php.

Zimmerman, R. MD. et. al. Functional Outcomes and Complications After Primary Spinal Surgery for Scoliosis in Adults Aged Forty Years or Older: A Prospective Study With Minimum Two-Year Follow-up. Spine:
15 September 2010 - Volume 35 - Issue 20 - pp 1861-1866
doi: 10.1097/BRS.0b013e3181e57827. Accessed: Oct 2010. http://journals.lww.com/spinejournal/Abstract/2010/09150/Functional_Outcomes_and_Complications_After.7.aspx

| Cobb Angle | Back Pain | Scoliosis (video) |

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Comments
October 26, 2010 at 2:27 pm
(1) TreatingScoliosis says:

Even with more severe curves, there are options other than surgery. Surgery should be seen as a last resort for the patient, after all non invasive efforts have been exhausted. Many times, marked improvement has been made with other therapies.

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December 26, 2012 at 7:13 am
(3) james says:

what are the therapies that may be effective then a surgery for Scoliosis?

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