My Spine - Lumbar
How is it diagnosed?
Once the deformity is noticed by the patient, the treating specialist will ascer-
tain the history to define the cause. A clinical examination will include the
forward bend test which exaggerates the chest wall prominence around the
shoulder blades.
The diagnosis is confirmed on a full-length X-ray taken both from behind and
the side while standing. Further views in flexed or extended positions may be
needed to determine the flexibility of the curve. MRI and CT scans may assist
in determining the underlying cause.
How is it treated?
Any dangerous underlying factors need to be excluded. If the deformity is
mild, the patient may be carefully monitored and if no progression occurs, left
untreated. If progression is expected based on the patient's age, curve size and
type, intervention is required.
Bracing is an option, but with poor compliance it is not always successful.
Patients find it hard to wear the brace for the required 20 hours per day.
Surgery is the mainstay of management of the larger, progressive curve; it is
dealt with in a later chapter.
Does this treatment have any complications?
All surgery involves risk. The general risk of infection is present and relative-
ly low at around 0.8%. It is lower with the anterior approaches. There is a
risk of non-union, or failure of the bone to fuse. Should this occur, the instru-
mentation will fatigue and break at around 12-18 months post-operatively
with pain and a loss of correction.
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