Index of Scoliosis Information

Scoliosis Surgery

Many surgical techniques can be used to correct the curves of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Fusion is the joining of two or more vertebrae. Surgeons can choose different ways to straighten the spine and also different implants to keep the spine stable after surgery. (Implants are devices that remain in the patient after surgery to keep the spine aligned.) The decision about the type of implant will depend on the cost; the size of the implant, which depends on the size of the patient; the shape of the implant; its safety; and the experience of the surgeon. Each patient should discuss his or her options with at least two experienced surgeons.

Patients and parents who are thinking about surgery may want to ask the following questions:

• What are the benefits from surgery for scoliosis?
• What are the risks from surgery for scoliosis?
• What techniques will be used for the surgery?
• What devices will be used to keep the spine stable after surgery?
• Where will the incisions be made?
• How straight will the patient's spine be after surgery?
• How long will the hospital stay be?
• How long will it take to recover from surgery?
• Is there chronic back pain after surgery for scoliosis?
• Will the patient's growth be limited?
• How flexible will the spine remain?
• Can the curve worsen or progress after surgery?
• Will additional surgery be likely?
• Will the patient be able to do all the things he or she wants to do following surgery?

From National Institute of Arthritis and Musculoskeletal and Skin Diseases

Spinal fusion with instrumentation

Spinal fusion is the most widely performed surgery for scoliosis. In this procedure bone (either harvested from elsewhere on the body, or donor bone) is grafted to the vertebrae so that when it heals, they will form one solid bone mass and the vertebral column becomes rigid. This prevents worsening of the curve at the expense of spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the thoracic or abdominal cavity, or performed from the back (posterior). A combination of both is used on more severe cases.

Originally, spinal fusions were done without metal implants. A cast was applied after the surgery, usually under traction to pull the curve as straight as possible and then hold it there while fusion took place. Unfortunately, there was a relatively high risk of pseudarthrosis (fusion failure) at one or more levels and significant correction could not always be achieved. In 1962 Paul Harrington introduced a metal spinal system of instrumentation which assisted with straightening the spine, as well as holding it rigid while fusion took place. The original, now obsolete Harrington rod operated on a ratchet system, attached by hooks to the spine at the top and bottom of the curvature that when cranked would distract, or straighten, the curve. A major shortcoming of the Harrington method was that it failed to produce a posture where the skull would be in proper alignment with the pelvis and it didn't address rotational deformity. As a result, unfused parts of the spine would try compensate for this in the effort to "stand up straight". As the person aged, there would be increased "wear and tear", early onset arthitis, disc degeneration, muscular stiffness and pain with eventual reliance on painkillers, further surgery, inability to work full-time and disability. "Flatback" became the medical name for a related complication, especially for those who had lumbar scoliosis. Modern spinal systems are attempting to address sagittal imbalance and rotational defects unresolved by the Harrington rod system. They involve a combination of rods, screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the Harrington rod. Spinal fusion is rarely performed without this instrumentation.

Modern spinal fusions generally have good outcomes with high degrees of correction and low rates of failure and infection. Patients with fused spines and permanent implants tend to have normal lives with unrestricted activities when they are younger, it remains to be seen whether those that have been treated with the newer surgical techniques will develop problems as they age. They are able to participate in recreational athletics, have natural childbirth and are generally satisfied with their treatment. The most notable limitation of spinal fusions is that patients who have undergone surgery for scoliosis are ineligible for military service in the United States.

In cases where scoliosis has caused a significant deformity resulting in a rib hump, it is often possible to perform a surgery called a "costoplasty" (also called "thorocoplasty") in order to achieve a more pleasing cosmetic result. This procedure may be performed at any time after a fusion surgery, whether as part of the same operation or several years afterwards. As stated before, it is usually impossible to completely straighten and untwist a scoliotic spine, and it should be noted that the level of cosmetic success will depend on the extent to which the fused spine still rotates out into the ribcage. A rib hump is evidence that there is still some rotational deformity to the spine. Specific weight training techniques can be used to influence this rotational deformity in the unfused parts of the spine. This leads to a marked decrease in pain and to some improvement in organ function depending on the person's particular case and is to be recommended over any cosmetic surgical procedure.

From Wikipedia, the free encyclopedia

IScoliosis.com provides specific information on different approaches and types of surgery. Click on the links below to see

Thoracoplasty | Anterior Approach | Posterior Approach


 Anterior & Posterior Approach | Minimally Invasive Approach



 Adult Scoliosis Surgery  | Bone Grafts | Osteoporosis


 Outcomes