OK, so we said adult scoliosis treatment was harder, but we didn’t say it was impossible.

Included in this category are the after issues of older post surgical cases. In the early days of surgical correction of idiopathic scoliosis there were things that simply could not be dealt with. Given newer surgical equipment and surgical methods some of those shortcomings can now be addressed. They are handled as a matter of routine in new cases. But, what about older already treated patients who missed that boat, so to speak? This is covered in the section called Revision Surgery.

Bend films, as in younger patients, tell us what kind of surgery is need on what part of the spine. Knowing where the spinal curve is rigid helps focus attention on undoing that rigidity as a first step before straightening.

Just because the spine is mature does not mean that hope is lost. Clearly, it is harder, and the surgery more likely to have to do a portion of the work from the front and secure it from the back side.

Blood loss is more in adults as the blood supply dives right into the bone from all surfaces. Blood supply in children avoids areas on the move and thus is easier to control.

Blood recycling technology and clotting control techniques have substantially helped.

Even plasma physics is used (a stream of argon plasma is electronically invigorated and sprayed over the operative field causing the tissues to seal). Alternate sources for bone graft have also substantially reduced the surgical assault and allowed a rapidity to recovery that even fifteen years ago was undreamed of.

The statistics of adolescent scoliosis tell us that maturity is about two maybe two and a half years after onset of menstruation at, say 14 years of age or so.

When spinal growth is done, then it is supposed to be over, the progression, that is. Right?

No. It is just statistics. Look deeper. If - BIG IF - the scoliosis curve is under 30 degrees at maturity (unbraced) then the chances of a substantive curve increase is quite remote.

But if it is 50 degrees, then it is absolutely certain that despite “maturity” the curve will progress, though slower.

 Around 40 to 45 degrees, flip a coin. You don’t have to be correct. Better is to be diligent. Follow it, just don’t be fooled by a small increment as progression can be 1 degree per year. That adds up. Some surgeons aggressively brace youngsters at lower numbers to avoid getting into this long term statistical game of chance. Put this into perspective. An 80 degree curve involving the chest region will have cut off all respiratory reserve (what you use when doing more than just watching television). There is nothing more to draw on. Now any exertion will not have increased respiration available to support it. That’s true disability.

The correction seen in the lower right inset isn’t just a cosmetic venture. It is like a life guard pulling a sinking soul above the water into the air. As a general rule, we like air. We like air a lot.  !8^)