Caging the curve: new surgery helps correct adult scoliosis

Tampa– Scoliosis — an abnormal curvature of the spine — doesn’t just affect children. Some doctors think the number of cases among adults could rise in the next 20 years as people live longer. In most cases, surgery is the last option for patients, but now doctors are trying a new approach that could mean a better outcome.

Walking is a serious milestone for Laura Hill. She says, “I’m all fixed. I’m fixed. It’s a miracle.”

Laura had adult scoliosis. It’s a disease that some doctors say could become more common as people continue to live longer.

“I couldn’t stand in the front of the ironing board. I couldn’t walk my dogs. I couldn’t take walks with my grandchildren,” Hill explained.

After years of failed treatments, neurosurgeons took a life-altering step for Laura by correcting the curvature in her spine.

Juan S. Uribe, MD, FAANS, Associate Professor of Neurosurgery at USF and Tampa General Hospital says, “This surgery is equivalent to a heart transplant or liver transplant.”

Instead of the traditional procedure which involves making a big cut in the back, Dr. Uribe used smaller incisions to insert plastic cages in-between her vertebrae. After making sure they were in the right spot, he screwed them into place.

“They work perfect if you do it right, but if you get a little bit out of the technique, then you can have really bad complications,” he explained.

The surgery is done in stages over the course of two days and recovery isn’t easy.

“I was in so much pain, from recovery pain, that was intense,” Hill said.

But now, “I can do everything,” she said. And that’s why even a seemingly simple activity marks a major step forward.

Over the two days of surgery, the surgeon works for about four hours and then takes x-rays to make sure the placement of the plastic cages is precise. The next day it takes about four hours to secure those cages. Dr. Uribe says surgery should be considered only after medication and lifestyle changes fail to bring relief.

BACKGROUND: Scoliosis affects two percent of women and 0.5 percent of men worldwide. The condition involves an abnormal curve or bend in the spine and over 80 percent of scoliosis cases have no known cause. The condition can run in families, especially those with a history of spina bifida, muscular dystrophy and cerebral palsy. There are three types of curves: a C-shape (levoscoliosis), a reverse C-shape (dextroscoliosis), and S-shape. Children and teens with untreated scoliosis can develop a more severe bend due to their skeleton’s fast rate of growth. Usually, doctors recommend seeking treatment for scoliosis if the curvature is greater than 20 degrees. Although scoliosis is commonly discovered in children, adult idiopathic scoliosis and degenerative scoliosis can be found in people, usually women, over the age of 40. Degenerative scoliosis is typically linked to osteoporosis.

TREATMENTS: Most adults with scoliosis do not have any debilitating symptoms and can be treated without surgery. In most cases, patients are prescribed pain medications like NSAIDs or are given physical therapy to improve flexibility and muscle strength. Some short-term use of braces is used for severe curvatures. The brace will not fix the curve or cause any changes in the shape of the spine but may cause some disintegration of the core muscles, so they are not recommended for long-term use. Patients that have persistent leg pain or pinched nerves can also benefit from an epidural or nerve block injections to reduce the severity of the pain. Surgery is typically reserved for patients with severe debilitating symptoms or reduced extremity control.

NEW TECHNOLOGY: A new approach to scoliosis surgery can potentially give patients their lives back. Instead of the traditional surgery which involves making a big cut in the back that can be very painful to heal from, doctors now use smaller incisions and place plastic cages in between the vertebrae. The surgery is done over two days and the surgeon works for about four hours in each stage. After the first stage, the doctor will take x-rays with the patient standing upright and obtains realistic feedback about the amount of deformity correction. The next day the surgeon will secure the cages by placing screws and rods using a minimally invasive approach. Juan Uribe, MD, Associate Professor at USF and Tampa General Hospital says, “Surgery should be considered only after medication and lifestyle changes fail to bring relief.” Dr. Uribe is a world renowned surgeon and teaches other doctors throughout the world. He recently went to Turkey to instruct other doctors on the procedure.
(Source: Juan Uribe, MD)

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