Kyphosis and Scoliosis

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Kyphosis and Scoliosis




Guest:  Dr. Bart Sachs – Orthopedic Surgery

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  One of the most exciting areas of new surgical techniques is in the treatment of conditions of the back and spine.  Dr. Bart Sachs is Professor of Orthopedic Surgery at MUSC and has been a pioneer in spine surgery, using both traditional and minimally invasive techniques.  In this podcast, he describes the common conditions of chronic spinal deformity, kyphosis and scoliosis, as well as the traditional surgical approach to treatment which is still commonly used.


Dr. Bart Sachs:  Really, the easiest way to think about scoliosis and kyphosis, in that order, is that when anyone looks at a person’s body, directly from the front or directly from the back, we should have a straight posture.  The shoulders should be level and even, waistline is even.  The pelvis is level.  People should be standing, pretty much, straight.  And the head should be balanced over the center of the body, right in the middle of the hips, viewing from the front or the back. 


A scoliosis involves a structural change of the spinal column, which is the foundation.  And what happens with the spine is, it starts to bend sideways and, at the same time, it twists around and turns.  One shoulder blade might stick out more than another.  The waistline of an individual changes and becomes asymmetric, sticks out on one side and is flatter on the other side.  One hip is usually higher than the other.  And people start to realize they’re out of balance.  Their head starts to shift and they start to lean to one side.  That’s what scoliosis is. 


Kyphosis is, basically, looking from the side of the person’s body, where, again, structurally, we should all be balanced.  Our head should be centered right over our legs and we could drop a plumb line down, and that’s what allows us to stand straight.  And, within range, we have a normal slight curve to our shoulders as we look from the side, and a little sway in the lumbar, lower back, area.  Again, those balance out.  A kyphosis is an exaggerated forward bend and forward hump of the upper part of the back where, looking from the side, an individual’s head is thrust forward and their shoulder blades stick out. 


These are not only common conditions, but they’re becoming more common conditions.  The reason that we’re seeing them more often is, it’s simple, people are living much longer.  We see people living a more full and active life and wanting to remain active as they age. 


Dr. Linda Austin:  Since kyphosis and scoliosis progress over time, it’s no wonder that they are often conditions most common in the elderly.  The elderly spine may be especially fragile, posing extra surgical challenges. 


Dr. Bart Sachs:  I can tell you an example of what brings people, finally, to treatment.  A very nice lady who I treated just within the last six to eight months was in her mid-eighties.  She happened to be one of the oldest people that I had treated for an elective scoliosis operation.  She came into my office and, before I went into the room, I saw her age and, inappropriately, made a determination that this person is too old.  So, I was going to have a discussion on how to live with this condition and accommodate your lifestyle.  And I walked in and found this very pleasant, energetic patient in her mid-eighties who told me that she had lost her husband.  She was there with her two daughters.


One of her joys in life was to participate and be a ballroom dancer.  She used to go out ballroom dancing Friday and Saturday night every weekend.  Her problem:  she was developing increasing pain, which was starting to limit her.  And, because of her scoliosis, it was advancing and getting much worse.  She was starting to lose her balance and lean.  Her biggest complaint was, she kept leaning on her partners, and her partners kept pushing her away, so she was losing her ability to dance.  She said she wanted to get back to dancing, whatever it took.   That’s what brought her in.  She came across three states.  She convinced me that she was a good candidate for surgery, underwent surgery and within two weeks, when I saw her return, she was standing straighter and walking.  And when I saw her four weeks after that, she was back to dancing.


Dr. Linda Austin:  To understand how the orthopedic surgeon treats back problems, Dr. Sachs describes a little about the anatomy of the spine.


Dr. Bart Sachs:  Our vertebral spine is composed of multiple small building blocks of bone, which are, in essence, stacked on top of one another.  And all of those building blocks are connected by soft tissue ligaments which tie the bones together, and then muscles which help to support those building blocks and allow continuous motion.  Then, there are spaces between the building blocks, called the disc spaces, and, obviously, the nerves, the spinal cord, runs within the space of the bony segments. 

The building blocks have collapsed.  They’ve lost their alignment.  They’ve twisted and they’re falling out of position. 


Dr. Linda Austin:  In order to straighten and stabilize the spine, sometimes it’s necessary to perform open surgery.


Dr. Bart Sachs:  The operation involves exposing and opening up areas of the spine, loosening up all of the contracted and scarred tissue around the building blocks so that each building block can be moved individually and separately, realigning those building blocks, putting them in the position they should be in, while protecting the nerves, of course, and then locking them together and holding them there. 


The technique of locking them together is with implants that we use in the spine, those implants being metallic implants, at this point, where we’ll place hooks, screws, or rods.  And, once the spine is lined up in the position we’d like for the patient, we attach to each particular building block, segmentally.  Then, once we’ve fixed to the bone, we take a rod, two rods, usually, and align the rods into the position the spine should be in and, in turn, place the rod attached to each of the building blocks and hold it there.


Dr. Linda Austin:  After the spine has been stabilized, or fixated, the body takes over, providing stabilization through the normal process of bone regeneration after injury.


Dr. Bart Sachs:  The body will lay down bone, and a fusion is really creating an underlying physiologic scenario in the body where the interpretation of the body is that there is a broken bone.  And, anytime there’s a broken bone, a natural tendency is for our bodies to heal that broken bone.  These are complex operations.  They’re long operations.  We’re detaching and moving each segment apart.  We have to do that very carefully and very delicately, and it takes time.  So, an operation, that I’ve just described, might be anywhere from 6 to 12 hours. 


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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