Paideia Spine Centre

Treating adult scoliosis is intended to alleviate the symptoms and not necessarily completely correct the curvature. The goal is always to reduce or eliminate pain, improve spinalfunction, and significantly improve quality of life.

Unlike adolescent scoliosis, which is almost always asymptomatic, age-related degeneration of the spine almost always leads to symptoms, especially disabling and persistent lower-back pain.

Over the last 15 years, improvements in techniques and instrumentation, as well as intra-operative monitoring, have vastly broadened the options for surgically treating scoliosis in adults, which can now be performed safely, in dedicated centres with experienced surgeons, even in patients over 50.

AIS is by far the most common type of scoliosis, affecting children between the ages of 10 and 18 years; it is diagnosed in 4 out of 100 adolescents. It is an orthopaedic disease. In general, AIS curves worsen during the patient’s rapid growth period. While the progression of most curvatures slows significantly upon reaching skeletal maturity, some, especially curves greater than 50-60°, continue to progress during adulthood. There are many theories about the cause of AIS, including hormonal imbalance, asymmetrical growth and muscle imbalance. It is certainly hereditary, which is why boys and girls who have a parent or direct relative with a history of adolescent scoliosis should be seen by an orthopaedic specialist/spine surgeon between the ages of 10 and 12, and for girls before their first menstrual cycle.

It is diagnosed via a clinical examination and completed with full X-rays of the spine, with two standing projections and a lateral bending view. Scoliosis up to 40 degrees of curvature is treated conservatively with corrective braces modelled on plaster casts; beyond 40-45 degrees, surgery is required to correct the thoracic and lumbar deformity, remove the hump and restore normal biomechanical function of the spine.

Spinal fractures must be seen as very serious conditions due to the potential risk of neurological injury.

They are divided into:

Spontaneous or fragility (osteoporotic)fractures , typical in adults and much more common in women. Osteoporotic fractures can be treated with a brace or with minimally invasive percutaneous surgical methods (vertebroplasty or kyphoplasty) performed under local anaesthesia and ensuring rapid patient mobilisation.

Traumatic fractures, more frequent in young people. Traumatic fractures, on the other hand, are caused by high-energy trauma (e.g. road accidents, falls from heights) and are often potentially unstable and may affect the spinal canal and spinal cord. These fractures require cord stabilisation surgery, which can be performed percutaneously or via open surgery.

Spinal stenosis occurs when the space within the spinal canal is too narrow. The narrowing of one or more spaces in the spine can put pressure on the spinal cord and nerve roots. Spinal stenosis occurs most often in the lower part of the spine (lumbar stenosis) and in the neck (cervical stenosis).

Spinal stenosis usually develops slowly over time. It is most commonly caused by osteoarthrosis or “wear and tear” that  occurs naturally in the spine with age. Narrowing occurs very slowly over the years. For this reason, the patient may have few symptoms until the reach the condition that is defined as moderate stenosis; when the diameter of the canal narrows excessively (tight stenosis), the pressure on the neurological tissue leads to increasingly severe symptoms, characterised by rapid leg weakness, neurological claudication, sciatica, pain, etc.

Tight stenosis is a deteriorating mechanical problem that significantly reduces the patient’s quality of life. The only solution in this case is surgery, which involves decompressing the neurological structures and then stabilising the spine. The operation, which can be performed even in very severe cases and in very elderly patients, completely solves the problem by restoring normal neurological function.

A herniated disc is a condition in which part of the nucleus pulposus protrudes from the annulus fibrosus into the spinal canal. It can affect the cervical and lumbar spine, rarely the thoracic spine. The causes may be mechanical or degenerative, but frequently the injury to the annulus fibrosus and the protrution of the nucleus pulposus is due to excessive physical stress (lifting a heavy weight, for example).

When the hernia is particularly large, it can compress the nerve root and cause pain that radiates down the arm (cervicobrachialgia) or leg (lumbocruralgia or lumbosciatica).

Prolonged compression of the nerve root can cause functional and anatomical damage to the root itself and lead to neurological deficits.

In these cases or in cases of acute pain resistant to conservative and pharmacological treatment and persisting for longer than 4-6 weeks, surgery may be recommended. The operation consists of removing, through a small incision, the herniated tissue and carefully releasing the nerve root (neurolysis). Decompression of the root leads to an immediate relief of symptoms and the patient can quickly return to normal daily activities.

Spondylolisthesis is an orthopaedic and spinal condition and affects 4-6% of adults. This condition occurs when a vertebra slips out of place onto the vertebra below it. Spondylolisthesis is considered a form of vertebral instability and can be caused by:

Spondylolysis, i.e. a fracture between the isthmus or pars interarticularis in the vertebral arch: isthmic lysis can be caused by trauma or stress (in young athletes) or is hereditary.

The vertebra may slip out of place due to a degenerative condition. The discs between the vertebrae and the facet joints (the two posterior parts of each vertebra that connect the vertebrae together) can wear out with age and no longer work as a posterior bond between two vertebral bodies.

Regardless of the cause, when the vertebra slips out of place, it applies pressure on the bone underneath.  Most cases of spondylolisthesis do not cause any symptoms, but when the disc is damaged due to being subjected to repetitive unnatural mechanical stress, the patient can develop chronic lower back pain that can be seriously debilitating.  Another frequent  symptom in patients with spondylolisthesis is pain in the legs, caused by compression or “pinching” of the nerve roots that pass through the spinal canal. The compression is a result of the vertebrae slipping out their normal position and the subsequent narrowing of the space required by the nerves.

When spondylolisthesis becomes symptomatic (lumbosciatica), surgery becomes a treatment option. The operation consists of realigning and stabilising the slipped vertebrae by implanting pedicle screws and replacing the disc with a cage (intervody cage) that fuses the two vertebrae together. The surgery is finalised by decompressing the nerve roots. As with other modern surgeries, this procedure is also performed using minimally invasive techniques.

Spinal cord tumours are neoformations that can develop in any segment of the spine, and can be benign or malignant:

– The most frequent benign neoformations are angioma, hemangioma, plasmacytoma and bone cysts

– Most malignant cases are metastases of a tumour that has spread to other sites, e.g. the lung, breast, prostate, and are primary spinal tumours; they are serious conditions that usually cause spinal cord compression and progressive neurological deficits

– Haematological tumours (myeloma and lymphoma) affect the whole skeleton, but particularly the spine

Vertebral tumours can cause pathological fractures and paraparesis/paraplegia.

Vertebral tumours may be located in the cervical, thoracic and lumbar spine. Benign tumours may present few symptoms, but persistent and continuous pain is the most frequent symptom in malignant tumours. They may be other symptoms, but they vary greatly depending on the size of the spinal tumour as well as the compression and subsequent damage to neurological structures.

Neurological symptoms include:

• tingling in the limbs (paresthesia);
• generalised weakness (asthenia);
• bowel and urinary incontinence;
• difficulty in walking;
• localised pain.

 Modern chemo- and radiotherapy have revolutionised both treatment and long-term survival of patients with spinal cord tumours in recent years.

Spinal tumour surgery is indicated in the presence of worsening neurological functions, in order to eliminate the compression of the affected nerve structures that causes the symptoms. It is almost always indicated in cases of pathological fractures.