What Is Scoliosis?
Causes
Scoliosis is classified as one of three types: idiopathic, congenital, or neuromuscular.
Congenital scoliosis arises from vertebral malformations during embryonic development, leading to curvature and deformities, and is usually detected early in life.
Neuromuscular scoliosis is associated with neurological or muscular conditions such as cerebral palsy or muscular dystrophy, progresses more rapidly than idiopathic scoliosis, and often requires surgical intervention.
Idiopathic scoliosis, accounting for about 80% of cases, is diagnosed when no specific cause is identified.
Symptoms
- uneven shoulders (one or both shoulder blades protruding)
- the head is not centered above the pelvis
- raised or unusually high hips
- rib cages at different heights
- an uneven waist
- changes in the appearance or texture of the skin over the spine
- dimples
- hairy patches
- color abnormalities
- the entire body may lean to one side
Treatment
Treatment methods for scoliosis include observation, bracing, and surgery.
Observation is suitable for children with mild curves, involving regular check-ups every four to six months during adolescence and X-rays every five years for adults unless symptoms worsen.
Bracing is effective for patients who haven’t reached skeletal maturity, especially for curves between 25 and 40 degrees, preventing progression in about 80% of compliant cases.
Surgery, such as posterior spinal fusion or anterior approach, is recommended for severe cases, particularly when curves exceed 40 degrees in children and 50 degrees in adults, or when accompanied by nerve damage or bowel/bladder symptoms.
Patient Recovery at Home
Preparing for a patient to come home after scoliosis surgery
Develop a nutrition plan: A healthy diet is essential for helping the spine’s bones grow and fuse after surgery. It is ideal if a friend or family member can assist with meal preparation during the first few weeks at home. If help is limited, it’s advisable to prepare healthy meals in advance that can be frozen, such as casseroles, or purchase nutritious frozen meals for easy preparation during the initial recovery period.
Create a plan for the bathroom: During the early stages of recovery at home, scoliosis surgery patients will need a toilet seat riser. Additionally, wiping may be uncomfortable initially, so having a special bottom wiper tool is advisable. Baby wipes can also be useful for maintaining hygiene.
Think through all daily tasks and how they may need to be altered: Consider all daily tasks and how they may need to be adjusted. Strenuous activities should be avoided or delegated during recovery. Even routine tasks like laundry or cooking will require assistance. Assistive devices, such as a grabber for picking items off the floor.
Maintain a hygienic living space: Maintaining a clean postoperative environment is crucial to preventing infections. Pets with dander and hair, like cats and dogs, can increase the risk of infections. It is important to limit or avoid contact with pets, especially in beds and couches, while the incision site is healing during the first few weeks.
First 14 days at home after scoliosis surgery
During the first 14 days at home, patients must adhere to basic precautions.
Avoid bending at the back (bending at the knees and hips is allowed), lifting anything heavier than 8 pounds (about a gallon of milk), and twisting the spine (use log roll method to get out of bed – video is attached below in resources). Sometimes patients will forget to refrain from these motions, however, the pain they feel when they move will remind them to refrain from those motions. Pain management is crucial, balancing effective pain control with the risk of narcotic addiction. In some cases, a back brace may be necessary to stabilize the spine. Ensuring pain is well-managed helps patients concentrate on tasks and move around, aiding the recovery process.
First 2 weeks - 3 months at home after scoliosis surgery
Rest remains crucial for recovery. As the recovery progresses, the surgeon will gradually lift some restrictions. Each patient is different, and no activity should be resumed without the doctor’s permission.
Start soaking in tubs if desired: After the incision wound has healed, the risk of bacterial infection through the site is eliminated, allowing the patient to submerge in water again. Activities such as taking baths or soaking in a tub or whirlpool can be resumed. However, care must be taken when getting in and out of the tub, and swimming should still be avoided.
Return to school: If the patient is of school age, they can generally return to classes within the first month post-surgery. Activities like gym class, exercise, and sports will typically require a longer recovery period, with decisions made on a case-by-case basis by the surgeon. Initially, patients may start with half days during their first week back at school. Additionally, some school districts offer home tutors to assist with schoolwork during the recovery phase.
Transition off narcotics: Most patients will transition from narcotics (opioids) to a milder pain medication like acetaminophen (e.g., Tylenol) within two to four weeks post-surgery. However, a few patients may take longer to discontinue narcotics.
Go out with friends: During the early stages of recovery, friends are allowed to visit the patient both in the hospital and at home. Around the four-week mark, the patient can begin going out with friends on a limited basis. However, they must be off narcotics before being cleared to go out.
Riding in vehicles: Aside from doctor visits, car rides should be avoided during the early recovery stages due to the risk of bending or twisting caused by potholes and bumps. As the patient continues to heal, the doctor may grant permission for more frequent vehicle rides.
Resources for Patients
Log Roll Demonstration for Getting in and Out of Bed After Spine Surgery
Scoliosis Brace
The video explains the use of a scoliosis brace, highlighting its purpose. Additionally, it demonstrates how the brace is designed to correct the curvature of the spine in scoliosis patients.