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Here is an example of a typical route for the
surgical management of the commonest type of scoliosis.
Let us take an example of an otherwise normal 14-year-old
girl with a 50° adolescent idiopathic scoliosis (idiopathic means no obvious
cause). The curvature will have been noticed a few months previously but often
not before it has reached 40–45° of curvature, which is the approximate
surgical threshold. Everyone feels guilty at not having seen it before but they
are not alone. It is the last thing expected, and teenagers are often secretive
about their bodies.
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Visit to GP It is usually helpful
if the GP can order an erect anteroposterior X-ray of the thoracic and
lumbar spines (front view of the spine) then if there is a long delay to see
the specialist at least we have a baseline. But it is vital that this X-ray
does not slow down referral to a scoliosis specialist. The GP should request
the X-ray and such referral at the same time.
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Referral to specialist scoliosis surgeon
Some patients are referred to General Orthopaedic Surgeons, and having
waited to see him or her they are then referred to the specialist, incurring
further delay. Scoliosis is not an emergency, but a delay of more than 4–6
months should not be tolerated.
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Consultation with scoliosis specialist preferably
with previous erect (standing up) X-ray of the spine (further x-rays will be
taken for comparison). If the curve is in excess of 40° to 45°, surgery
may be recommended (0° is straight). The specialist will explain the risks
and benefits of surgery. Patients should not be afraid to ask questions
because that is the best way to reduce anxiety. They should make sure they
understand what is involved, along with any special features of their case.
Further information:
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