Dr Adriaan Liebenberg My Spine Explained | Page 49

My Spine Explained
How is it treated?
Dangerous underlying factors should be excluded. If the deformity is mild,
the patient is carefully monitored and if no progression occurs, it is left
untreated. If progression is expected based on the patient's age, curve size and
type, intervention is required. Bracing is an option, but not always successful,
because patients find it hard to wear the brace for the required 20 hours per
day. The more pronounced and progressive curves are treated with surgery.
Does this treatment have any complications?
The general risk of infection is present and relatively low at around 0.8%; it
is lower with the anterior approaches. There is a risk of non-union, or failure
of the bone to fuse; should this occur, the instrumentation will fatigue and
break at around 12–18 months post-operatively with pain and loss of correc-
tion. The risk most feared is neurological injury (paralysis) and although rare,
is ever present with a chance of 1:300 of any neurological event from some
numbness to total paraplegia (unable to move or feel legs). This can occur
from the corrective process and increased strain on the spinal cord or from
reduced blood supply to the cord. To reduce this risk, some specialists use
spinal cord electrical monitoring during the procedure; this is not fail-safe and
has its own technical challenges. Should there be a problem in the immediate
post-operative phase; urgent instrumentation removal may be required. Speak
to your specialist about a more comprehensive list of possible complications.
What are the long-term expectations?
It depends on the type and underlying cause. Severe scoliosis, greater than 70
degrees, poses a risk to lung function, and greater than 100 degrees increases
the risk of mortality. Smaller curves remain a cosmetic and psychological
issue, but not a medical threat. Curves less than 40–60 degrees in the younger
age group usually don’t progress after maturity and do not have an adverse
effect on enjoyment of life. Curves greater then 60 degrees will progress and
surgery should be considered. The degenerative type tends to progress and
increasingly causes nerve root pain.
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