Scoliosis and Devices Instrumentation

KEY FACTS

Terminology

• Spinal fusion surgery recommended when curve magnitude > 40-45° for adolescent idiopathic scoliosis

• Adult scoliosis presents with lumbar back ± leg pain, L3-L4 rotatory subluxation, L4-L5 tilt, and L5-S1 disc degeneration on radiographs

Imaging

• Radiographs

  • Main thoracic, thoracolumbar, and lumbar curves should be assessed for structural characteristics

  • 36′ standing anteroposterior & lateral radiographs & supine side-bending radiographs

  • In adult scoliosis, assess for degenerated changes and rotatory ± lateral listhesis

• CT

  • Assess integrity of hardware

  • Look for osseous bridging at levels of interbody fusion and lucency along screw tracks

• MR

  • Preoperative planning to evaluate for central &/or foraminal stenosis and disc degeneration

Clinical Issues

• Adult bones tend to be weaker or osteoporotic, making instrumentation and fusion more difficult

• Degenerative disc changes, spinal stenosis, and facet arthropathy can be exacerbated and in turn exacerbate scoliosis, leading to more rigid spines

• Goals: Prevent progression, restore acceptability of clinical deformity, reduce curvature, prevent neurologic deficit

  • Resolve pain ± make it more controllable with medications

  • Fuse spine in as normal anatomical position as possible

TERMINOLOGY