KUALA LUMPUR - Patients suffering from S- or C-shaped spine or scoliosis often have serious doubts when told they need to undergo surgery to correct their crooked back.
Their main concern is the risk of paralysis should the operation to place the spinal implants to straighten their backs fail.
However, Dr Mohd Hisam Muhd Ariffin, an orthopaedic and spine surgeon at Universiti Kebangsaan Malaysia Medical Centre, Cheras, who has done no less than 155 scoliosis surgeries and 524 spine operations from 2009 until August, said that with modern technology, the neuromonitor and improved surgical techniques, the risk faced by patients is less than one per cent.
From his experience at the spine clinic in UKM Medical Centre, he said most of the patients were aged between 13 and 15.
The clinic handles 30 to 40 scoliosis cases a week. Spine cases account for 75 to 100 cases.
These numbers do not include patients who go to the UKM Specialist Centre, the private wing.
Scoliosis is the side-to-side bending of the spinal curve, presenting a three-dimensional deformity instead of a straight line.
There is still a lot of misconception and misunderstanding pertaining to the condition and its causes, he said, leading to patients and their families not being receptive to corrective surgeries.
"When patients present themselves after X-rays, we will calculate the curvature and determine if they were from suffering mild, moderate or severe scoliosis.
"Mild scoliosis is when the spine curvature is 25-30 degrees, moderate at 30-50 degrees and severe, more than 50 degrees.
"In China and South Korea, mild scoliosis patients are operated on for aesthetic reasons as it improves their self esteem," said Dr Hisham.
Usually the curving does not progress further once the patients reach skeletal maturing in their mid-20s, but for those who suffer severe scoliosis before their 20s, there is a progression rate of 0.6-1 degree every year.
Untreated scoliosis could steadily become worse and affect the patient's daily functions.
"Imagine if you are diagnosed with a 50 degree curve at 20. By the time you reach 40 years old, your backbone would curve 70 degrees.
"At this stage, you could face diminished lung function due to the distortion and stiffness of the rib cage. This would affect the heart pumping capacity and if not corrected would eventually lead to right heart failure.
"This is because the lungs cannot expand and this restrictive lung function will backfire on the heart on the right side leading to the failure of the right side of the heart caused by long-term high blood pressure in the pulmonary arteries and right ventricle.
"That is the reason for surgery, to prevent the progression and correction of this condition," he said.
The goals of the surgery are both to prevent curve progression and obtain curve correction by placing implants fixed with nuts and bolts.
The rods will hold the spine in the corrected position until fusion is achieved.
For those in the moderate category, doctors need to follow up as there are currently no statistics available to show how they fare.
Dr Hisham points out that scoliosis is classified into thoracic, lumbar and thoracolumbar scoliosis.
As for the cause, 80 per cent of cases is idiopathic scoliosis, affecting teenagers where the cause is still unknown.
There is also infantile scoliosis (below age 5), juvenile (5-11) adolescent (above 11), adult (above 20) and denovo or degenerative scoliosis affecting those above 40.
Statistically, three per cent of the patients could not walk after surgery but with today's surgical techniques supported by neuromonitors that track the state of the patients during the surgery, the risk of paralysis has been reduced to just 0.6 per cent.
"Previously, we used to do wake-up tests during the operation to check on the patients' progress.
"We would only know if the patient could be paralysed just before closure of the stitches.
"Today with such improved technology, equipment and the spine surgeons' experience, most patients need not even be wheeled into the intensive care unit after surgery for recovery," he said.
Typically, most of them could walk by the third day with the help of therapy and they are encouraged to do so to ensure faster recovery, even among some of the older patients.
Generally, the recovery period is between five and seven days, and patients should be able to return to school or work in just three to six weeks.
Full recovery is between three and six months after surgery.
Patients are advised not to bend or carry heavy weights for 18 months.
Head of the Orthopaedics and Traumatology Department, UKM Medical Centre Dr Azmi Baharudin said there was usually a two- to four-member team of surgeons work in close cooperation to tackle especially difficult cases.
"We are vigilant about the patients and the anaesthetist, with the neuromonitor, makes sure surgery is safer and more successful.
"We have successfully cut down the time of such operations from more than six hours about five years ago to half that now.
"With simpler cases, we can do it within 90 minutes. The shorter the time, the better and faster the recovery for the patient," he said.
Dr Hisam added that the risk of infection to surgical wounds had also been much reduced now with the use an antibiotic powder, vancomycine.
Witnessing a recent operation at the new operating theatre on a patient whose backbone was curved 80 degrees and who was also a heart patient, it was impressive to see the camaraderie among the four surgeons operating on the challenging patient.
The surgeons had to work fast as the heart patient could not tolerate a too-long sedation and completed the job within three hours.
Dr Hisam's expertise has received due international recognition as he has been invited to countries, such as Brazil and South Africa, to share his knowledge and experience in scoliosis operations.
Furthermore, surgeons from Denmark and South Africa have also come to learn more about the surgery techniques from him.