Scoliosis: Warning Signs and When to Brace or Operate

The spine is made up of three main components, each with its own nutritional needs: bones need calcium, vitamin D and sunlight; muscles and tissues need exercise and good protein in the diet; nerves need exercise and vitamin B12. Altogether, a good lifestyle, diet and exercise are what keep the spine healthy.

For idiopathic scoliosis, once the curve goes beyond 40 to 45 degrees, bracing has failed and surgery is indicated. On plates: long plates such as Steffee plating are no longer used - for the last 15 to 20 years, the standard has been transpedicular screws with a titanium or PEEK cage instead.

There is no real obstacle - the obstacle is in the mind. As an example, three minimally invasive spine surgeries (two of them revisions of prior laminectomies) were performed in Abuja, Nigeria over the last two months, and all three patients were walking the next day; this has already led to inquiries from ten different hospitals wanting to start similar programmes. It is a matter of local doctors taking the initiative, supported by training and partnership.

The first line is medicine and physiotherapy. If that doesn't help, a nerve block injection is the next step. If that also fails, endoscopic surgery is used.

With minimal invasive and robotic techniques, the patient walks the same day, is discharged in one to two days, can return to work within a week, and can return to active sports within three weeks.

One shoulder higher than the other, an off-centre head over the pelvis, one prominent hip, one side of the rib cage sticking out, or a skin abnormality over the spine.

Beyond 40 degrees for idiopathic scoliosis; congenital scoliosis from a hemivertebra should be operated on at age 4-5 regardless of curve size, since delay makes the eventual surgery far larger.