Scoliosis surgery

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Scoliosis Surgery
Scoliosis is a condition that causes the spine to
curve sideways. Some curvature in the spine is
normal, but if the curves are too severe, pain
and other complications can result. Scoliosis
most often occurs during the time when a child is
rapidly growing, near the onset of puberty. The
condition can be caused by other diseases such as
muscular dystrophy and cerebral palsy, but most
of the time the cause of scoliosis is unknown.
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Why the Scoliosis Surgery is performed

• There are several reasons to treat scoliosis
• Appearance is a major concern.
• Scoliosis often causes back pain.
• If the curve is severe enough, scoliosis affects
  your child's breathing.
• Braces are often tried ?rst to keep the curve
  from getting worse.
• The choice of when to have surgery will vary.
• After the bones of the skeleton stop growing, the
  curve should not get much worse. Because of this,
  the surgeon may wait until your child's bones
  stop growing.
• Your child may need surgery before this if the
  curve in the spine is severe or is getting worse
  quickly.
• Surgery is usually recommended for the following
  children and adolescents with scoliosis of
  unknown cause (idiopathic scoliosis)
• All young people whose skeletons have matured,
  and who have a curve greater than 45 degrees.
• Growing children whose curve has gone beyond 40
  degrees. (Not all doctors agree on whether all
  children with curves of 40 degrees should have
  surgery.)

3
Surgical approaches

• Different Surgical Approaches may be used
• Posterior approach (back)
• This approach has been the gold standard for
  years and continues to be a surgical procedure
  applicable to most patients with scoliosis.
• The incision is made on the back, just over the
  spines midline.
• Anterior approach (front)
• Certain abnormal curves are ideally suited to
  this approach. Many thoracolumbar
  (thoracic-lumbar) and thoracic curves are
  approached this way. The instrumentation The
  anterior approach is often done using scopes and
  is termed video-assisted thoracoscopic surgery,
  or abbreviated VATS. Patients are hospitalized
  for three to six days.
• Anterior-Posterior Approach (Front-Back)
• Generally, one curve is approached from the front
  and back. If there is a second curve, it is
  approached only from the back. Sometimes, if
• there are two severe curves, a double
  anterior-posterior procedure is performed.
• The anterior approach is the standard procedure
  performed to treat lumbar (low back) curves. It
  is performed through the patient's side to access
  the front of the spine. Anterior surgery can be
  performed using a scope inserted into the
  thoracic spine also called thoracoscopic
  surgery.
• The anterior-posterior approach is more involved
  than a single anterior or posterior procedure.
  Surgery may last six to 10 hours, the average
  hospital stay ranges between ?ve days to two
  weeks, and recovery takes longer than a single
  approach procedure.
• Thoracoscopic surgery (VATS, or Video-Assisted
  Thoracoscopic Surgery)
• This is a technique that applies to thoracic
  spine surgery. Not every patient with a thoracic
  curve is a VATS candidate. The procedure requires
  that one lung be temporarily de?ated some
  patients, due to anatomical reasons cannot have a
  lung de?ated. Also, some curves do not allow for
  easy access to the spine using VATS. Of course,
  there are other reasons why VATS is not an option
  for some patients.
• Small incisions called portals are made in the
  side of the chest. Scopes, cameras, and video
  monitoring devices are used by the surgeon to see
  the spine. These devices help make spine surgery
  less invasive to the patient while providing
  equal or better results. There is minimal effect
  on lung (pulmonary) function with VATS as our own
  studies and multiple other studies have shown.
• After surgery, the small incisions are well
  hidden by the patient's arm. Scars are much
  smaller and more cosmetically appealing than
• standard open procedures.

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Surgical procedures

• The scoliosis spine surgeon will choose the
  procedure that best treats the patient's problem.
  Sometimes more than one surgery produces the most
  favorable results. The surgeon will present the
  pros and cons of the different procedures so the
  patient and their family can make an informed
  decision with his guidance.
• Choices for scoliosis surgery include
• Spinal Fusion this surgery most often
  performed for scoliosis
• Thoracoplasty (rib resection, rib
  removal)
• Osteotomies (bone removal)
• Hemivertebrae excision (partial or
  complete removal of a vertebra)
• Vertebral column resection

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Surgical procedures
Spinal Fusion for Scoliosis A Spine Surgery
Option for Spinal Deformity
Scoliosis surgery and surgery for other types of
spinal deformities requires the spine eventually
to be fused solid as the current standard. Fusion
is the process where motion segments (vertebrae)
are welded together using bone grafts. The
procedure usually involves implanting two metal
rods (stainless steel or titanium) to correct the
abnormal curvature. Sometimes more than two rods
are needed. A combination of screws, hooks, and
wire may be used to anchor the rods to the spine.
Biologically speaking, the process of spinal
fusion to completion takes three months to one
year. During that time, the progress of the
fusion is evaluated on x-rays. Bone graft comes
from different sources such as the pelvis (iliac
crest of the hip), ribs, or the spine (local bone
from the surgery site). Using local bone lessens
the patient's pain caused by harvesting bone from
other areas of the body. Allograft or cadaver
bone is also often used and eliminates donor site
morbidity.

• In addition, protein bone graft substitutes
  (BMPs) may be used in select cases such as when
  an established failure of fusion
  (pseudoarthrosis) has occurred.
• Since smoking interferes with fusion, patients
  should make every effort to stop months before
  their surgery. Smoking cessation should
• continue after surgery.
• Important Spinal Fusion Details
• In younger patients and adults with satisfactory
  bone density (strength), bracing is not used
  after surgery.
• Posterior instrumentation (eg, rods, screws)
  without fusion or "growing rods" can be performed
  in patients with juvenile or infantile scoliosis
  under age 10. Growing rods allow for
  straightening of the spine and subsequent
  lengthening procedures until the patient reaches
  adolescence when a ?nal fusion procedure is
  performed.
• The average hospital stay for most operations
  ranges from four to seven days.

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Thoracoplasty (Rib Resection)
Surgical procedures
Patients with scoliosis often have a prominent
rib hump. One of the goals of correc- tive
scoliosis surgery is to correct the rib
hump. Thoracoplasty is a surgical procedure that
helps to reduce rib hump size. The procedure
involves partially removing as many as ?ve ribs.
This procedure is usually performed as part of
the scoliosis surgery, but it may be performed at
a later time. Sometimes a chest tube drain is
needed for a day or two after thoraco- plasty is
performed. Thoracoplasty is less commonly
performed today than before because current
advances in spinal instrumentation results in
improved rotational correction of the deformity.
Osteotomies (Cutting and Removing Bone)
Surgical procedures
The term osteotomy means cutting into and
removing bone. Osteotomies are performed in the
front or back of the spine. In treating scoliosis
curves, an osteotomy is used to improve
correction of the spinal deformity. Osteotomies
are used to treat adults with rigid scoliotic
curves, children with large curves causing
deformity, ?atback correction, and in spinal
reconstructions where realignment is needed after
a prior spinal fusion.
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Surgical procedures Hemivertebrae Excision
(Removal) A hemivertebra is a wedge-shaped
vertebral body. A normal vertebra is shaped like
a rectangle. This abnormality forms before birth
and may result in scoliosis or kyphosis as the
individual grows. If scoliosis or kyphosis is
progressive, and the patient is off balance, the
abnormally shaped vertebra can be surgically
removed. The surgical procedure is performed
using an anterior-posterior approach or, more
commonly today, solely from a posterior approach.
The instrumentation (eg, rods, screws) is
implanted posteriorly and patients are often
braced for several months after surgery.
Surgical procedures
Vertebral Column Resection (VCR)
This procedure involves removing one or more
complete vertebrae either using an anterior-
posterior (front-back) or all posterior (back)
approach. In the thoracic (ribbed spine) portions
of the ribs, both sides that correspond to the
resected areas, are removed. Essentially, the
spinal column is detached, realigned, and
connected back together using spinal implants.
This type of surgery is reserved for more severe
curvatures and carrier greater neuro- logical
risk than other procedures. Results are most
often extremely gratifying to the patient.
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Risks

• There may be complications with any of the
  procedures for scoliosis repair.
• Risks of any anesthesia are
• Allergic reactions to medicines
• Breathing problems
• Risks of any surgery are
• Bleeding
• Blood clots in the legs that may travel to the
  lungs
• Heart attack or stroke during surgery
• Infection, including in the lungs (pneumonia),
  bladder, or kidney
• Possible complications from any scoliosis repair
  surgery are
• Blood loss that requires a transfusion.
• Gallstones or pancreatitis (in?ammation of the
  pancreas).
• Infection.
• Intestinal obstruction (blockage).
• Nerve injury causing muscle weakness or paralysis
  (very rare).
• Lung problems up to 1 week after surgery.
  Breathing may not return to normal until 1 to 2
  months after surgery.