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June marked Scoliosis Month: A Mediclinic expert explains how this condition can severely impair quality of life and how he recently performed a successful surgery to turn around a teenage patient’s life.
Scoliosis is a three-dimensional curve in the spine, and in most cases, wearing a brace helps straighten this curve, says Dr Jaytesh Pillay, an Spinal Orthopaedic Surgeon at Mediclinic Kloof. But sometimes surgery becomes necessary, as in the case of Dané Steyn, a 15-year-old patient who underwent a successful spinal procedure.
Understanding scoliosis
Scoliosis is not just a side-to-side curve, but a curve that occurs when the whole spine is rotated, Dr Pillay explains. “It can happen in the middle or bottom of the spine or sometimes in both areas, resulting in a complete deformity.”
The condition can be congenital (diagnosed at birth), or neuromuscular, causing muscular problems and an imbalance in a child’s growth. But the most common form is adolescent idiopathic scoliosis (AIS), for which the cause is unknown.
“We usually see AIS in girls when they start reaching puberty,” says Dr Pillay. “Initially, they don't have much pain, which is why they don't complain. Their parents also don't realise anything is wrong until the curve becomes noticeable, or they notice an imbalance in their daughter’s shoulders.”
In the case of AIS patient Dané Steyn, the signs were picked up early on. When Dané was seven years old and doing child modelling, her mother Nicolene noticed that both her knees would move inwards. A friend suggested they take her to an orthopaedic specialist.
The specialist ordered X-rays, which led to her being diagnosed with scoliosis. Since she was so young, the doctor recommended monitoring the curve’s progression and sent her to physiotherapy, which initially yielded some improvement. “The curve was around 18° at the time of diagnosis, so it wasn’t yet in the danger zone,” Nicolene explains.
Treatment options
The most common treatment for scoliosis, when caught early, is a brace – usually worn for 23 hours a day for a few years. “An orthotist makes the child a brace that moulds to the shape of the curve,” Dr Pillay explains. “The brace can potentially bring the curve down as close as possible to normal. Kids grow with the brace until around 14-16 years old, when their spine stops growing and they no longer need the brace.”
However, in Dané’s case the brace failed to correct the curve sufficiently. The specialist then recommended surgery, which involves inserting rods and screws around the spine to straighten it.
In the years following her diagnosis, Dané did not get consistent X-rays and the COVID-19 pandemic further delayed investigations. But when Nicolene saw how pronounced her curve had become, she made an appointment with Dr Pillay, who discovered that it had progressed to 56°. Dané subsequently wore a fitted brace for around a year. At the beginning of 2023, despite initial progress, Dr Pillay found her back had again begun deteriorating and he recommended surgery. The surgery went ahead on 30 October, allowing Dané time to complete her growth spurt.
At first, 15-year-old Dané was reluctant. “I was scared something was going to go wrong or I was going to be paralysed,” she says. But after doing some research and watching videos of success stories, she decided to go ahead. “After making the decision, I was excited and counted down the days to the surgery.”
Wearing the brace when sleeping had been comfortable as it kept her spine in place, Dané says, but she found it difficult at school. “She had to wear baggy clothes to hide the brace. Kids would ask about it and they tend to mock those who are different in any way,” says Nicolene. “Dané didn't want to be the ‘weird child’, so having the surgery really changed her life.”
Spinal surgery
Doctors generally take a conservative approach, and only operate if the curve doesn’t improve with the brace. However, surgery ensures that the spine stays straight for life without the need for a brace. Scoliosis surgery requires extensive planning, a large medical team and can take between 4-6 hours, Dr Pillay explains.
“We cut through the back and do an open surgery, putting screws on either side of the spine. Then we bend the rod according to the normal curvature of the spine, manipulating the spine back into its straight position. We also make carefully planned cuts that assist in making the spine straighter.” Patients stay in hospital for about 3-4 days and the recovery period is around six weeks, with the final follow-up appointment three months post-surgery. Patients are then sent to a biokineticist for exercises to prevent future problems.
“A multidisciplinary team is involved in treating the patient, including myself, a clinical associate, physiotherapist, dietitian, psychologist, paediatrician, and biokineticist,” Dr Pillay says. “The patient and their family will meet with the team, who address questions before surgery, so they’re well prepared. “We find that patients who mentally prepare for the surgery do so much better.”
Patients are given a list of activities they can and cannot do afterwards, for example, competitive horse riding. But overall, they can live a normal life post-surgery. Dané’s mom says that two weeks later, it was as if she’d never had an operation. “If I hadn’t kept her at home, she would have gone and run the Comrades, she just wanted to move! She’s a different child. In February this year, she restarted hockey practice and toured with her team in April. Her life now goes on as if nothing had ever been wrong.”
