The anterior approach for scoliosis surgery is done through an incision made in the front or, more commonly, the side of the body. The anterior approach may be used for middle or lower spinal curves.This technique is better for severe curves, including rigid curves in adults. But it has greater surgical risks than posterior surgery alone. Surgeons often use both the anterior and posterior approaches when they operate on a person who has scoliosis. Using this combination of techniques, surgeons can remove discs in the spine and graft bone into the spaces. This is done to help make the spine more correctable.Other techniques done with an anterior approach use large metal screws that are attached to each vertebra. Each screw has a large head with a hole for the passage of a rod that is tightened at each level. A brace or cast may be needed for about 6 months following surgery. This technique is not recommended for children younger than 10 years because of the small size of their
The posterior approach for scoliosis surgery is done from the back of the body. It involves making a long, straight incision into the back and moving aside the back muscles to reveal the spine.Rods, wires, hooks, or screws are attached to the spine in various ways. The spine is repositioned and held in place with these mechanisms while the new bone surface fuses. Bone grafts, often taken from the person's pelvic bone or ribs, are put in place to help the spinal bones fuse together in a permanent position over time.
The Risser sign helps measures the risk that a curve in the spine (scoliosis) will get worse, or progress. It measures how much mature bone has developed (ossification) in the upper rim of the pelvis (iliac crest). Values range from 0 (least ossification and greatest risk of progression) to 5 (complete ossification and least risk of progression). This is determined by an X-ray.
The cosmetic aspects of scoliosis and the braces used to treat it may greatly affect a child or teen.Teenagers may find wearing a brace devastating to their self-image. Most braces should be worn for 20 hours a day or more, usually for several years. It is very difficult to get teens to wear the brace for as many hours as their doctors recommend. They don't like how the braces look or feel. Also, wearing a brace may limit activities such as horseback riding, skiing, skating, and gymnastics. Other activities, though, such as biking, tennis, running, and jumping, are safe to do while the brace is worn. It is typically recommended that children be allowed to remove their braces to take part in physical education classes and other highly desired activities. This may encourage better use of the brace.Newer braces are designed to improve the chances they will be worn as recommended.
A doctor may test a young person for scoliosis during a routine physical exam. In schools, screening may be provided annually for students between the ages of 10 and 14 (grades 5 through 9). The exam takes about 30 seconds and may be done by a school nurse or physical education teacher.The examiner first views the child from behind, looking for uneven shoulders, hips, or waistline or for shoulder blades that stick out or are uneven.The child then bends forward from the waist, with the arms hanging down loosely and the palms touching (forward-bending test). The examiner looks for any unevenness, such as one side of the rib cage that is higher than the other. The examiner may also view the child from the side to detect a hump on the upper back (kyphosis).Also, the examiner may measure the angle of trunk rotation (ATR) with a device called a scoliometer. Some states require screening for scoliosis by law. But health experts don't agree with whether or not to screen for scoliosis.1, 2