Back on track after successful scoliosis surgery

Posted on 23 July 2021

Doctors at Mediclinic Kloof performed complex, innovative surgery to straighten the spine of a teenage girl with adolescent idiopathic scoliosis.

“She does tae-kwon do; she plays under-19 chess at 14 years old. I think the lowest mark she’s ever achieved at school is 94%. She has plans for her life that we can’t imagine. So when the doctors explained scoliosis, and what it could mean, how it could limit her life or restrict her potential, we knew we had to do something.”

Casey Kooiman first noticed something wrong in his daughter’s posture when she was 12 years old: a slight curvature in her back, just noticeable enough to nag at the back of his mind. After an initial misdiagnosis, Nicola began to complain of pain and discomfort in her everyday movements.

He began to research scoliosis, and its potential treatments, and came across Dr Jaytesh Pillay, a spinal orthopaedic surgeon at Mediclinic Kloof. After a series of X-rays and MRI scans, Casey’s fears were confirmed. The curve in his daughter’s spine had begun to worsen, creating a twist and bend that could, if left untreated, lead to significant deformity later in life.

This is known as adolescent idiopathic scoliosis – an abnormal curvature of the spine that appears, without a clear cause, in a patient’s late childhood. The spine usually develops a curve towards the sides of the body, and this is accompanied by twisting or rotations of the bones of the spine as well.

Today, Nicola is on the road to recovery, and to realising her full potential, after Dr Pillay and his team performed a long and complex spinal fusion procedure to realign and fuse together the curved vertebrae so that they heal into a single, solid column.

“It is fairly rare surgery – technical, and risky,” says Dr Pillay. “Because we are dealing with a person’s spine, we are working with nerves and tissue that are delicate and crucial. So there are many people involved, and it is a painstaking, step-by-step process.”

Dr Pillay explains Nicola’s condition as a three-dimensional curve in the spine. “The spine was approaching an S-shape, and it was also twisting, and bending, towards the front. What we have done is insert a series of rods and screws to turn the spine and hold it in a straighter, more natural position.”

In many cases, scoliosis can be treated through the use of braces. Nicola’s curvature had worsened to the point where surgery was required, despite the risks. “If we had left it? Over years, the curve would have worsened further, putting pressure on her chest and abdomen. At that point you’re looking at constant chest infections, significantly reduced mobility, and compromised quality of life.”

The doctors had to act, and fast. At 14 years old Nicola is approaching the end of her growing stage, and her curve was clearly getting worse – after many consultations with both her and her parents, Dr Pillay and his team felt compelled to proceed.

This was not an easy decision, as the surgery itself had its risks. “The main danger we are concerned with is damage to the nerves,” says Dr Pillay. “We are placing these screws close to the spinal cord, and turning the spine itself – if we are not careful, we risk the patient losing mobility in the arms or legs, or becoming paralysed.”

One member of Dr Pillay’s team was specifically tasked with constantly monitoring Nicola’s nerve function in real time, as the surgeons worked. Electrodes were attached to her head, fingers and toes, and continuous signals were sent to and from her brain to her extremities. Any interruption would indicate a complication, and would necessitate the surgeons undoing and restarting the procedure.

Nicola was admitted at 7am and only came out of surgery in the late afternoon. After a long day in theatre, Dr Pillay says he was tired, but relieved. “After all the months of pre-operative planning, and the hours of intense concentration in there, with the whole team playing their part, we had no serious complications and we should have a good outcome.”

Casey is equally relieved. “Nicola is a very bright girl who knows her own mind. She has a very clear picture of the future she wants for herself – and we’re just grateful, now, that she won’t have this condition holding her back.”