According to the National Scoliosis Foundation, scoliosis affects nearly 6 million children, teens and adults, with the typical onset occurring between ages 10 and 15. Scoliosis surgery is designed to reduce the patient’s curvature and fuse the spine to prevent any further progression of the deformity. Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Severe curvatures (greater than 50 degrees) are more likely to progress in adulthood. If a curve is allowed to progress to 70 - 90 degrees, it will not only result in a very disfiguring deformity, but will start to result in cardiopulmonary compromise.
What is Scoliosis?
Scoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an x-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line. Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred), or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma).
What is Scoliosis Surgery?
Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed on children or adult. The operation takes approximately six hours. Hospitalization can last several (usually around six) days and activities are restricted for several months. Scoliosis is best treated when found early and can be detected during a routine school screening.
Types of Scoliosis:
There are several types of scoliosis. Each of them are named and defined according to the age, cause of scoliosis and spinal curvature. There are two basic types of scoliosis:
Structural: is caused by neuromuscular diseases, certain infections, birth defects, injury, connective tissue disorders, metabolic diseases, rheumatic diseases, tumors and other unknown factors
Nonstructural: or functional scoliosis is reasoned by underlying conditions such as a difference in leg length, muscle spasms, or inflammatory conditions including appendicitis.
Idiopathic scoliosis: is the most common type of scoliosis based on age. It affects about 4% of the population, commonly females. The reasons may include differences in leg length, hereditary conditions, injury, infections and tumors. It is subdivided into three categories:
Infantile scoliosis: extends from birth to age three
Juvenile scoliosis: is caused between the ages three and nine
Adolescent scoliosis: scoliosis extends from 10 to 18
Other Types of Scoliosis are:
Congenital scoliosis: is a rare type of scoliosis caused by an abnormally shaped bone that presents at birth.
Neuromuscular scoliosis: is a lateral curvature of the spine occurring due to muscular weakness or neuromuscular disease such as cerebral palsy, spina bifida, paralytic conditions, spinal cord tumors, neurofibromatosis and muscular dystrophy.
Degenerative scoliosis: happens in adults due to weakening of the spine with aging.
Scoliosis is also categorized on the basis of the spinal curvature. Thus following are the types found:
Thoracic curve scoliosis,
Lumbar curve scoliosis
Thoracolumbar curve scoliosis
Causes of Scoliosis:
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent and it is generally believed to be multi-factorial, although genetics are believed to play a role. Various causes have been implicated, but none of them have consensus among scientists as the cause of scoliosis, though the role of genetic factors in the development of this condition is widely accepted. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly, but occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord. Admittedly, the cause is unknown or idiopathic; having been inherited through multiple factors, including genetics. Scoliosis often presents itself, or worsens, during the adolescence growth spurt and is more often diagnosed in females versus males.
These symptoms are only those associated with the spine being curved:
Your head may be off center.
One hip or shoulder may be higher than the other.
You may walk with a rolling gait.
The opposite sides of the body may not appear level.
You may experience back pain or tire easily during activities that require excessive trunk (chest and belly) movement.
How is Scoliosis Diagnosed?
Past diseases or surgery, and diseases in your family are also important information. The caregiver may ask your child to bend forward, which may help show any deformities on his back. Your child's shoulders, hips, legs, and ribs may also be checked. How well your child moves and feels things may also be tested. Your child may also need the following tests:
X-rays: Several x-ray pictures may be taken of your child's spine, including views taken from the back and sides. Your child's caregiver will carefully look at the x-rays to check the curve or shape of the spine. Other problems, such as broken, incomplete, or fused bones may also be seen. Your child's caregiver may also check if your child's bones are still growing.
CT scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's bones, muscles, brain, body organs, and blood vessels. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if your child is allergic to shellfish, or has other allergies or medical conditions.
MRI: This test is called magnetic resonance imaging. During the MRI, 3-D (three-dimensional) pictures are taken of your child's body. An MRI may be used to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his MRI. Never enter the MRI room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.
Types of Scoliosis Surgery:
Scoliosis surgery is usually recommended by orthopedists for curves that have a high likelihood of progression (i.e., greater than 45 to 50 degrees magnitude), curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing. There are two main types of surgery:
Anterior Fusion: This surgical approach is through an incision (cut) at the side of the chest wall;
Posterior Fusion: This surgical approach is through an incision on the back and involves the use of metal instrumentation to correct the curve.
Surgical Approaches and Procedures for Scoliosis Surgery:
The scoliosis spine surgeon will choose the procedure that best treats the patient's problem. Sometimes more than one surgery produces the most favorable results. The surgeon will present the pros and cons of the different procedures so the patient and their family can make an informed decision with his guidance. Choices include: Posterior approach (back)
Anterior-posterior approach (front and back)
Anterior approach (front)
Thoracoscopic surgery (VATS, Video-Assisted Thoracoscopic Surgery)
Thoracoplasty (rib resection, rib removal)
Osteotomies (bone removal)
Hemivertebrae excision (partial or complete removal of a vertebra)
Vertebral column resection
Posterior Approach (Back): The posterior approach has been the gold standard for years to treat scoliosis and continues to be a surgical procedure applicable to most patients. The procedure usually involves implanting two metal rods (stainless steel or titanium) to correct the abnormal curvature. Sometimes more than two rods are needed. A combination of screws, hooks and wire may be used to anchor the rods to the spine. A spinal fusion procedure helps to weld the bone grafts and vertebral of the spinal column into a solid mass. Thoracoplasty involves rib resection (partial or total removal) to decrease the size of the rib hump caused by scoliosis. The rib bone can be used as a source of bone graft used in the fusion procedure. Today, with pedicle screw fixation, Thoracoplasty is less commonly performed than previously. The average hospital stay for most operations ranges from four to seven days.
Spinal fusion with instrumentation: Spinal fusion is the most widely performed surgery for scoliosis. In this procedure, bone (either harvested from elsewhere in the body autograft or from a donor allograft) is grafted to the vertebrae so that when it heals they will form one solid bone mass and the vertebral column becomes rigid. This prevents worsening of the curve, at the expense of some spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the thoracic or abdominal cavity or, more commonly, performed from the back (posterior). A combination is used in more severe cases. Originally, spinal fusions were done without metal implants. A cast was applied after the surgery, usually under traction to pull the curve as straight as possible and then hold it there while fusion took place. Unfortunately, there was a relatively high risk of pseudarthrosis (fusion failure) at one or more levels and significant correction could not always be achieved.
Thoracoplasty: A complementary surgical procedure a surgeon may recommend is called Thoracoplasty (also called costoplasty). This is a procedure to reduce the rib hump that affects most scoliosis patients with a thoracic curve. A rib hump is evidence that there is some rotational deformity to the spine. Thoracoplasty may also be performed to obtain bone grafts from the ribs instead of the pelvis, regardless of whether a rib hump is present. Thoracoplasty can be performed as part of a spinal fusion or as a separate surgery, entirely. Thoracoplasty is the removal (or resection) of typically four to six segments of adjacent ribs that protrude. Each segment is one to two inches long. The surgeon decides which ribs to resects based on either their prominence or by determining those which are unlikely to be realigned by correction of the curvature alone. The ribs grow back, and will grow back straight.
Preparing for Scoliosis Surgery:
If you are considering Scoliosis surgery you should be sure to ask your surgeon the following questions:
What will happen if I don't have surgery?
What type of surgery will work best for me?
What implants will be used?
How straight will my spine be after surgery?
How long will the operation take?
What are the risks of this surgery?
What are the benefits to getting this type of surgery?
What is the scar like?
How long will I have to remain in the hospital after the surgery?
How long will it take to recover?
When can I start being as active as I was before surgery?
What permanent restrictions are there on activity?
Can I talk to another patient/family that had the surgery?
Postoperative care after Scoliosis Surgery:
Following scoliosis surgery, patients can usually start to move around about 2 to 3 days after the surgery and when they start feeling better, and total hospital stay is usually about 4 to 7 days. Patients can return to school about 2 to 4 weeks after surgery, but their activity needs to be limited while the bone is fusing.
It is important to note that the more immobile the spine is kept the better it will fuse. Bending, lifting, and twisting are all discouraged for the first three months after surgery. For this reason, some surgeons will prescribe wearing a back brace for a period following the surgery. Any physical contact or jarring type activities are restricted for about 6 to 12 months after surgery.
Generally the patient will be monitored with intermittent examinations and x-rays for 1 to 2 years after the surgery. Once the bone is solidly fused no further treatment is required.
For the most part, patients can resume normal activity levels after a thoracic fusion since fusing the thoracic and upper lumbar spine does not change the biomechanics of the spine all that much. Female patients who have had a scoliosis fusion can still become pregnant and deliver babies vaginally.
Prognosis - Scoliosis Surgery:
The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression (i.e., if the patient has not yet completed the adolescent growth spurt).
Benefits of Scoliosis Surgery:
Surgery is an option used primarily for severe scoliosis (curves greater than 45 degrees) or for curves that do not respond to bracing. Following are the primary benefits of successful scoliosis surgery:
Curve: One of the most drastic benefits of scoliosis surgery is stopping the progressive curvature of the spine. Not only will this help alleviate health issues associated with scoliosis, but it will also help from a cosmetic standpoint.
Lung and Heart Health: Scoliosis can have a negative effect on heart and lung health. Damage to these organs occurs as the curve reaches 70 degrees. A curve of 100 degrees can cause serious damage, especially as the rib cage begins to press against the heart and lungs. By performing surgery early enough in the progression of the disease, the spinal curve can be stopped before it causes further damage.
Future Prevention: Some advantages of scoliosis surgery are not necessarily immediate. Catching scoliosis early on and preventing it from progressing can save the patient from developing other painful related issues such as chronic back pain, arthritis of the spine etc.
Scoliosis Surgery in India:
Of late India has emerged as a pioneer in the field of health sector dealing the best to global patients suffering from scoliosis and other medical ailments. A large number of leading spines, Neurosurgery and Orthopedic Centers of India are present which offer the highest possible standards of spine and neuro healthcare to patients. India has world class panel of spine and Orthopedic expertise and have provided surgery and medical treatments to most complex cases of Spine like the Degenerated Disc Disease, Multi Level Herniated Discs, Scoliosis, Kyphosis, Spinal Stenosis, Spondylolisthesis, Spinal Tumors, Spinal Fractures and Malformations.
The hospitals catering Scoliosis surgery in India happen to a top class modern treatment centres abreast with latest technology as witnessed in the developed nations. Most of them are accredited with JCI accreditations, which are approved once they follow stringent protocols of quality and hygiene. Increasing quality of medical facilities with affordability factors do bring a huge rush of foreign patients all across the world, wherein they get quality health care and best medical services.
The hospitals and clinics are spread over more than 15 cities of India and with more than 5,000 healthcare professionals have the most advanced medical facilities in the world and use the best internationally recognized medical systems where the patients get their scoliosis surgeries.
These are available at hospitals in the following cities with latest amenities and state-of-art-facilities.
The additional care the global patients get while undergoing through their respective medical treatments or surgeries surpasses all the value added services they avail at their respective places.
Cost of Scoliosis Surgery in India:
Advanced methods of treatment are available in India at quiet affordable prices. India offers an incredibly low cost which goes to around 60-80% less than prevailing USA rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. The following cost comparison is a good curtain raiser for patients looking for medical services in India.
Procedure Cost (US$)
Posterior Approach (Back)
Some of the common countries from which patients travel to India for surgery are:
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.
Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.
Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.
Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India,
Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra..
Kerala - Welcome to Kerala, state in India's southern tip and a state known as God's Own Country. Kerala is one of the ten 'Paradises Found' by the National Geographic Traveler, for its diverse geography and overwhelming greenery. It is a land much acclaimed for the contemporary nature of its cultural ethos, and much appreciated for the soothing, rejuvenating paradise that it is.
Delhi - Delhi, the capital of India is situated in the northern part of the country. Apart from being the capital of India, Delhi is also the travel hub of northern India. It serves as an excellent base for visiting the colorful state of Rajasthan, and Agra, the city of the Taj Mahal, is less than three hours away. Discover the many tales behind Delhi’s ancient, bewitching existence. Feel the excitement of stepping foot on a piece of the world’s oldest land!
Pune - Pune is the eighth largest city in the India state of Maharashtra. The city derives its name from Punya Nagari, which means 'the city of virtuous deeds.'Pune or the 'Queen of Deccan' is known for its educational, research and development institutions. This beautiful city has many exotic locales attracting innumerable tourists.
Jaipur – Jaipur is located in India and attracts a flurry of tourists from all over the world. Sited within eastern Rajasthan, North India, the city of Jaipur is famed for its hilltop fortresses, magnificent royal palaces and historic pink-painted sandstone architecture, earning it the affectionate nickname of the 'Pink City'.
Chennai - Chennai formerly known as Madras is the capital city of the Indian state of Tamil Nadu. It is famous for its culture and tradition. Chennai hosts a large cultural event, which includes performances by hundreds of artists. The city has a vibrant theatre scene and is an important centre for the Bharatanatyam, a classical dance form.
Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium City.' Gurgaon has recently emerged as the latest hub for Medical Tourism. Apart from being IT hub and a favorite haunt for MNC offices, the city has a number of world class hospitals that not only treat Indian citizens but also people from outside.
Chandigarh - Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads. India’s first planned city, Chandigarh is a rich, prosperous, spic and span, green city rightly called “THE CITY BEAUTIFUL”.
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