By June Spence

Most of us remember Adam’s Forward Bend Test, though few of us are familiar with that name: you fold forward at the waist, arms dangling, and an examiner eyes your spine for any swerves in the ridgeline of vertebrae connecting your neck and the small of your back.

Children lined up for such annual scoliosis screenings used to be a familiar sight in school gyms across North Carolina. The problem was, says Duke orthopaedic surgeon Robert Fitch, MD, the process was expensive and largely ineffective.

Scoliosis includes any curvature of the spine that measures 10 degrees or greater; it’s quite common, says Fitch, who specializes in children and adolescents, and the vast majority of people who have it require no treatment at all. “After mass screenings, I’d end up with a flood of referrals. It amounted to a lot of unnecessary anxiety for parents.”

Those schoolwide screenings are no longer the norm -- nowadays pediatricians and general practitioners are the ones who keep their eyes on growing spines -- and a great deal more has changed in the way scoliosis is addressed.

For kids and still-growing teens whose curves are at 25 to 40 degrees, those awkward, cumbersome back braces once worn 24/7 have for the most part given way to lightweight devices that fit easily under clothing and allow for greater movement. “For certain curve patterns, a nighttime brace may even be sufficient,” says Fitch.

Adult Surgery Turned Sideways

Spine surgeon Christopher Brown explains a new procedure for adults with scoliosis.Scoliosis treatment for adults has also undergone significant remodeling. People whose spinal curves and accompanying pain are severe enough to need correction now have the option of minimally invasive surgical techniques, which means reduced hospital stays and shorter recovery times.

Scoliosis patients’ fear of back surgery is understandable, says Duke orthopaedic surgeon Christopher Brown, MD. The traditional surgical approach to correcting scoliosis involved “large, open incisions,” he says. “We had to cut all the way down the back, strip all the muscle off the spine, and insert screws and rods. If the correction was in the thoracic [chest] area, we might have to remove a rib or deflate a lung to reach the spine.”

With the minimally invasive approach, Brown makes one small incision directly over the side of the waist and another slightly behind it. He works through these incisions to place cages -- plastic implants -- in the disk spaces between the vertebrae, he explains.

“With the new procedure we can work right in the disc space, attacking curves where they begin. The discs themselves are so much of the problem, and this method approaches them directly; we’re trying not only to straighten curves, but also to stabilize the new alignment.”

This sideways, or lateral, approach to the spine means that the surgeon can avoid
both cutting through the large muscle groups on the back and maneuvering around the organs of the abdomen.

“Nerve-monitoring technology helps us avoid nerves -- that’s the technology that makes these small incisions possible,” notes Brown. “There’s less pain and a much lower infection rate because we’re not causing so much destruction to the tissues. Patients go home quicker -- on average three days earlier. Some even go home the next day.”

The procedure has broader applications than scoliosis, he says. “I use it any time a patient is a candidate for a fusion. I don’t operate on the lumbar spine without it for any of kind of stabilizing procedure.”

Kids’ Curves

For children and adolescents, whose spines are still developing, surgery is only done in very extreme cases with children or adolescents; the hope is to correct via bracing. For those rare cases that require surgery, the classic open procedure is still the norm. Kids simply fare much better than adults with the classic open procedure, says Brown. “They fuse and heal quickly, and they don’t get the infections that adults get.”

But the procedure is now less onerous for children and adolescents as well, explains Fitch. “What’s changed the most are the surgical implants, which have evolved to sophisticated degrees, allowing for better deformity correction, fewer post-op complications, and quicker recovery. We used to have to go through the chest to loosen the spine, then perform a separate procedure to plant the rods. What used to take two surgeries now takes one.”