Scoliosis Surgery

Derived from the Greek word, "crooked," scoliosis is actually a three-dimensional deformity that can pose a serious problem for children and adults, especially young girls who are more at risk than boys. However, many tremendous advances have occurred in the field since the first scoliosis surgery was performed in 1930, and the exceptional scoliosis physicians at Montefiore Medical Center have consistently been at the forefront of these incredible techniques and technological developments, with the goal of helping patients restore maximum mobility through the proper contour of their backs.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 3-5% of children develop scoliosis, and Dr. Vishal Sarwahi, Director of Spine Deformity Surgery, estimates that only 2% of those diagnosed with scoliosis require treatment. However, because treatment for scoliosis - especially surgery - is not as common as many other procedures, it's critical that patients seek a hospital with scoliosis surgeons who are dedicated to correcting all types of spinal deformities. Dr. Sarwahi performs more than 100 scoliosis operations each year, and he and his team treat patients from around the globe, as well as in the New York Metropolitan area for various types of spinal curvature.

Genesis of Scoliosis/The First Doctor Visit

While the cause of scoliosis is unknown - or idiopathic - in approximately 80% of all cases, doctors attribute genetics as the genesis of the deformity. "Parents really can't take precautionary measures," Dr. Sarwahi explains. "But an annual exam performed by a pediatrician or school nurse will reveal any asymmetry in the back. If any humping occurs or if one shoulder is higher than the other, the patient needs to consult a doctor."

The first visit with a scoliosis expert entails a variety of questions pertaining to back pain and breathing issues, as well as a neurological exam. "The three-dimensionality comes from not only the curve of the spine, but also a twist of the back created by a rib hump," Dr. Sarwahi expounds, adding, "And if severe enough, it could compromise the heart and lung functions." Hence if trouble breathing is an issue, it could portent a serious case of scoliosis. This discussion is followed by the most crucial step, the X-ray, which determines the treatment plan.

Non-Surgical Treatment Options

Many cases of scoliosis are quite mild and, therefore, only require monitoring a patient via X-rays and an annual physical examination. Doctors can assess the severity of a curve from the X-ray by measuring the angle of the vertebrae at the beginning and end of the spine and quantifying the degree. If a patient amidst his or her growth years has a curvature of 10-25 degrees, it may be necessary to conduct an examination every four to six months. As long as the curve does not exceed that degree interval, then no further treatment is typically warranted.

If the curve crests over the 20-25 degree range, but is still falls under the 45-degree mark, bracing is usually recommended for patients. "While braces do not correct scoliosis, they prevent the curvature from increasing," Dr. Sarwahi states. "If the curve is contained to 35 degrees or less, the patient will not need surgery." Success rates with braces hover around 75%. Should the curve advance beyond 45 degrees, surgery may be required.

Distinguished Surgical Expertise

Montefiore Medical Center was one of the first hospitals in the world to embrace the surgical procedure utilizing pedicle screws, rather than rods, for better stabilization of the fused vertebrae during surgery. For 40 years, the standard procedure for correcting a curve was to place two hooks in the back of the vertebrae with one rod connecting them. The problem? "Sometimes these rods would break," Dr. Sarwahi notes. "Now we are placing the pedicle screws in the spine from the back to the front in order to allow a stronger fixation. The success rate is nearly 100%, as opposed to 50%-60% from the previous procedure," he adds.

For parents fretting about the possibility of paralysis, Dr. Sarwahi says the chance is less than 1% because he works far from the nerves when performing this surgery. "People are often apprehensive of spine surgery, but this procedure is actually safer than driving a car day to day."

As for the recuperation, children typically return home five days after surgery and adults, 10-14 days. "The recovery is so fast," Dr. Sarwahi beams, "No brace or cast is needed." On average, children and adolescents may engage in daily activities six weeks to two months later, and adults approximately six months afterwards. "It's a radical change of lifestyle, as patients can return to their normal lives much, much sooner than years ago."