Principal Director, Orthopaedics, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi
Part 8 of 8 in Adolescent Idiopathic Scoliosis
Scoliosis Complications: Untreated Progression, Surgical Risk and a Post-Traumatic Case
August 4, 2024
Left untreated, a curve over 45 degrees in a skeletally immature patient will keep progressing, roughly one degree per year even into adulthood, eventually causing back pain, radiating leg pain, nerve compression and, in very severe curves beyond 70-80 degrees, cardiac and pulmonary restriction.
Real surgical complication rates
Asked directly what the most common complications of surgical correction are and how they're prevented, Dr. Miglani gave real numbers: neurological injury under 1%, respiratory complications around 2-8% (higher when a rib resection or osteotomy is involved), infection under 1%, mesenteric artery issues around 2.7%, and paralytic ileus in 2-4% of patients, which resolves with conservative management. He also addressed intraoperative neuromonitoring directly: it's used routinely for curves over 60-70 degrees, and keeping the monitoring system active throughout every corrective step is what keeps neurological complication rates under 1%.
A live patient case: post-traumatic scoliosis
One participant shared a personal case during the session: a traumatic scoliosis with a Cobb angle of 22 degrees, following a spinal injury sustained during a resuscitation attempt in 2021. Dr. Miglani's guidance was direct: without pain in the affected area, a curve of that size that has already stabilised does not need bracing or any active intervention, and X-rays and clinical photos would be needed for a fuller review.
This article is based on a Jivo Masterclass session conducted by Dr. Manoj Miglani, Principal Director, Orthopaedics, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Manoj Miglani taught doctors across Africa on August 4, 2024.
FROM THE LIVE Q&A
Dr. Paul Kambala
You said between 3 to 6 months for the X-ray follow-up. Can you clarify how that's decided?
Dr. Manoj Miglani
If the child is young, say 10 years old with a 20-degree deformity, X-rays should be done every 3 months since they are likely to progress more. If the child is 13-14 years old with the same 20-degree curve, X-rays every 6 months to a year are enough, just to confirm the deformity isn't progressing rapidly.
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Frequently Asked Questions
Is there any preventive treatment, such as exercises, bed positioning or diet, that can help avoid developing scoliosis or keep it from progressing?▼
No, there are no preventive measures for idiopathic scoliosis, because the actual cause isn't known. The only genuinely useful advice is for the child to stay physically active, which most children naturally are.
Is there a difference between true scoliosis and scoliosis attitude?▼
Yes. Scoliotic attitude is purely a postural thing, not a structural curve. A true structural curve is distinguished from a postural presentation using standing X-rays and bending views, which show whether the curve is rigid or fully correctable.
As a traumatic scoliosis patient from DRC with a Cobb angle of 22 degrees, should I wear a custom-made corset or a removable corset with physiotherapy sessions?▼
At a Cobb angle of 22 degrees, correction may not be needed at all. If there is no pain in the affected area of the spine, the curve is unlikely to progress further and has likely already stabilised, so no bracing or active intervention is required. X-ray pictures and clinical photos would be needed for a fuller review of the specific case.
Can you say something regarding intraoperative monitoring during operative treatment of AIS?▼
Intraoperative neuromonitoring is used routinely for curves more than 60-70 degrees, which makes the surgery much safer. The monitoring system stays active throughout the procedure, with checks after every screw placement and after every corrective manoeuvre, which is what keeps neurological complication rates under 1%, even for nerve root injury.
When treating AIS with bracing: how many hours per day should a brace be worn, what are the indications for considering the treatment a failure, and when should surgical options be considered after failure of bracing as non-operative management?▼
A brace should be worn for 22 hours a day to be effective. Treatment is considered a failure if the deformity progresses both clinically and radiologically despite bracing. Surgery should be considered once the child has more than 40 degrees of deformity with growth still remaining.
What are the most common complications of scoliosis surgery?▼
Neurological injury under 1%, respiratory complications 2-8%, infection under 1%, mesenteric artery issues around 2.7%, and paralytic ileus in 2-4% of patients, which typically resolves conservatively.
Does a stable, painless 22-degree post-traumatic curve need bracing?▼
Generally no. If there's no pain in the affected area and the curve has already stabilised, no active intervention is needed, though X-rays and clinical photos should be reviewed to confirm.
In This Series: Adolescent Idiopathic Scoliosis
- 1.Adolescent Idiopathic Scoliosis
- 2.What Is Adolescent Idiopathic Scoliosis? Epidemiology and the Unknown Cause
- 3.Diagnosing and Classifying Scoliosis: Cobb Angle, Curve Types and True vs Postural Deformity
- 4.The Risser Sign: Predicting Whether a Scoliosis Curve Will Progress
- 5.Treatment Thresholds: Observation, Bracing and Surgery by Curve Severity
- 6.Why Bracing Has Real Limits: Brace Types, Compliance and When It Fails
- 7.Surgical Correction: From the Harrington Rod to Modern Pedicle Screw Fixation
- 8.Scoliosis Complications: Untreated Progression, Surgical Risk and a Post-Traumatic Case