Bones, Muscles & Joints (Orthopaedics)
Scoliosis physicians at Montefiore Medical Center improve patients' mobility by straightening their backs. Montefiore, the first hospital to use pedicle screws in spinal surgery, has nearly 100 percent success rate in this surgical procedure.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five percent of children develop scoliosis. Vishal Sarwahi, MD, Director of Spine Deformity Surgery, estimates that only two percent of those diagnosed with scoliosis require treatment. However, treatment for scoliosis - especially surgery - is not as common as many other procedures. It is critical that patients seek a hospital with surgeons who have expertise in scoliosis and are dedicated to correcting all types of spinal deformities. Montefiore has a surgical team specialized in scoliosis surgery. Dr. Sarwahi performs more than 100 scoliosis operations each year. He and his team treat patients from around the globe, as well as 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 percent of all cases, doctors attribute genetics as the basis of all scoliosis deformities. While there are no precautionary measures, an annual exam performed by a pediatrician or school nurse will reveal any asymmetry in the back. If any humping occurs or one shoulder is higher than the other, the patient will need to consult with a doctor.
"The three-dimensionality comes from not only the curve of the spine, but a twist of the back (can also) create a rib hump," Dr. Sarwahi said, "and if severe enough, it could compromise the heart and lung functions."
During the first visit with a scoliosis expert, the patient answers questions about back pain and breathing issues and takes a neurological exam. Labored breathing could indicate a serious case of scoliosis. After the consultation with the physician, the patient receives an X-ray, which determines the treatment plan.
Non-Surgical Treatment Options
Many cases of scoliosis are quite mild and require only X-rays and an annual physical examination. Physicians can assess the severity of a curve by looking at the X-ray. Our physicians and radiologists use the most advanced technology for scoliosis testing. If a patient during his or her growth years has a curvature of 10 to 25 degrees, it may be necessary to conduct an examination every four-to-six months. As long as the curve does not increase, further treatment is not necessary.
If the curve is over 20 degrees, bracing is usually recommended for patients. While braces do not correct scoliosis, they prevent the curvature from increasing, according to Dr. Sarwahi. If the curve is contained to 35 degrees or less, the patient will not need surgery. Success rates with braces are around 75 percent. If the curve advances beyond 45 degrees, surgery is required.
Distinguished Surgical Expertise
Montefiore is one of the first hospitals in the world to perform a procedure using pedicle screws, rather than rods, for better stabilization of the fused vertebrae during surgery. We are placing the pedicle screws in the spine from the back to the front in order to allow a stronger fixation, instead of a rod which tends to break. The success rate is nearly 100 percent, as opposed to 50 to 60 percent from the previous procedure, according to Dr. Sarwahi.
For parents worried about the possibility of paralysis, Dr. Sarwahi said the chance is less than one percent because he works far away 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."
Children typically return home five days after surgery; for adults, 10 to 14 days, and no cast or brace 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."