Scheuermann's Kyphosis
	Adult Scoliosis

In the 1960s and 1970s, the first large-scale efforts to screen school children for scoliosis were initiated. These programs were designed to identify children who had an abnormal curvature of the spine and who might respond favorably to treatment as a child, rather than as an adult. Many of these children eventually received a spinal fusion in order to straighten their spine and stop their curves from becoming worse.

The fusions that were done twenty and thirty years ago were very different operations than those done today. They often required several different stages, long periods of hospitalization, bed rest, and body casting. The instrumentation that is commonly used today for spinal fusions was not developed yet, and as a result, it was technically much more difficult to correct an abnormal curvature in the spine and hold it in the corrected position while the fusion was occurring.

Many patients who were treated during this era tell stories of large and cumbersome braces, very difficult surgeries, and long and painful courses of rehabilitation. Some of these patients have a difficult time seeking medical treatment now because their prior experiences were so difficult, and they occasionally discourage others from receiving treatment as well. However, the management of spinal deformities and the science of spine surgery has made incredible advances over the past three decades, and as a result, braces are much smaller, surgeries are shorter and less painful, pain control is much better, and rehabilitation is faster and easier.

Spine surgeons have also learned several important lessons from the treatment of spinal deformities over the years. Many patients who were treated with a spinal fusion two or three decades ago have lived very full and productive lives without any significant back problems. However, the long-term consequences of spinal fusion surgery are real, especially when a long segment of the spine had to be fused in order to correct a scoliosis.

When many vertebral segments of the spine are fused together, the remaining mobile segments assume much more of the load and the stress associated with bending, twisting and lifting. Over time, degenerative changes occur in the mobile segments above and below the spinal fusion, and this process is called "adjacent segment disease". This can result in painful arthritis of the discs, facet joints, and ligaments. Adjacent segment disease may be a more common consequence after spinal fusions that were done when the techniques for spinal fusion were less sophisticated than they are now. For instance, the first generation of Harrington Rods used pure distraction, or separation of the ends of the curve, as the force used to correct the curvature. This type of correction alters the biomechanics of movement at the next level down in the spine, resulting in early arthritis in this area.

Surgeons now make every attempt to minimize the amount of damage to the adjacent segment and also align the adjacent segment as much as possible so that is not subjected to any unusual loads or stresses. However, painful adjacent segment disease is a real problem, especially when it affects patients who are only in their thirties and forties. When this process occurs as a result of the earlier treatment of scoliosis, a complete evaluation by a surgeon who specializes in spinal deformity is warranted.

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