Originally posted by Tina_R
View Post
There really aren't any "rules", but most of the top docs start to think of fusing skeletally immature kids when they are mostly grown and when their curves reach around 50 degrees. For skeletally mature kids who hit 50 degrees, the kid and their parents are usually given the option to decide if/when they have surgery. Those are typically the guidelines for adolescent idiopathic scoliosis. Other types of scoliosis frequently don't fall into those guidelines. And, sometimes there are underlying issues that affect the decision.
Younger adults (say <40 years old) are sort of treated like skeletally mature adolescents. These people may be able to avoid surgery the rest of their lives, so the decision to have surgery is left to the individual, and can be put off for years. It used to be that older adults were told to wait and see how much their curves progressed over a period of time (typically 5 years). Now, I think most of the top specialists wait for the patients to tell them if/when they're ready. It's almost always based on pain and loss of function, and not curve magnitude. Some people with very small curves can have a lot of degeneration. And, some people with very large curves can have no pain. The only time I hear surgeons talk about curve magnitude as part of the surgical decision in this population is when a patient has large curves, and there is proven progression. For example, a 40 year old with a 50 degree curve is expected to progress at about 1-1/2 degrees a year. That means that when that patient is 80 years old, they could have a 110 degree curve. At the point, that patient will likely start having heart and lung issues.
Hope that helps clear it up.
Comment