Continued
investigation of every area that could relate to the deformity.
SURGICALTREATMENT
Surgical treatment is indicated when deformity increases despite appropriate orthotic management, or when a patient presents with a curve already too large for bracing - which is happening more frequently under managed care. Most scoliosis surgeons will recommend operative correction for curves measuring more than 45°, as these most likely will progress in adult life. Treatment is individualized and based on many factors in addition to curve magnitude, including rotation, balance, thoracic lordosis, cosmesis and symptoms.
The major goals of surgery are: achieving a solid fusion, correcting deformity, early mobilization, and minimizing complications. For the past 30 years, surgeons treated spine deformity with the Harrington rod which applies distraction
Numerous ancillary developments have made reconstructive spine surgery quite safe, even for adults with advanced deformity requiring staged anteroposterior surgery. At Shady Grove, autotransfusion, argon beam cautery and hypotensive anesthesia have minimized the blood loss that in earlier days made spinal surgery adventurous at times. Intraoperative evoked potential monitoring of the spinal cord has virtually eliminated the likelihood of neurologic injury.
Until the underlying cause or causes of scoliosis is determined, we will continue to treat it as a physical sign and not as adiagnosis. For most patients, the treatment will be simple observation; for a few, bracing will be prescribed; and for a few, surgery will be recommended. We will continue to approach scoliosis as we did polio 50 years ago treating the symptoms while awaiting a breakthrough in genetics or neurophysiology that will respond to preventive measures.
FOLLOW-UP
For more information on the management of spinal deformity at Shady Grove Adventist Hospital, contact Dr.John Stinson at (301) 251-1433 or Dr. Margaret Peterson, the hospital's Vice President for Patient Care, at (301) 279-6520.