Everyone has spinal curves; a certain degree of curvature is necessary so you can move, walk and balance properly. But in some people, the spine curves too much to one side or the other. This is called scoliosis.
If the condition is severe, the spinal curves are usually visible – the body no longer looks symmetrical, or balanced. It may also be painful, and the condition could eventually contribute to other health problems.
If your doctor considers your curve to be mild he may prescribe external bracing. However, if there is significant curvature of the spine – typically more than 45 degrees – your doctor could recommend corrective spinal surgery. Surgeons make decisions regarding the type of surgery that is appropriate for your case depending on the type, severity, and location of your particular spinal curve.
There are several approaches to spinal surgery for scoliosis. Each involve fusing – or joining together – the vertebrae in the curve to be corrected. The goal is to both reduce the abnormal curve in the spine and to prevent it from getting worse. A spinal fusion involves placing bone graft or bone graft substitute in the spaces between each vertebra and fastening instrumentation, such as rods and screws, to the vertebrae to be fused. This instrumentation serves as an “internal cast” to help realign and stabilize the vertebrae while the graft heals and the bones fuse properly.
Anterior Approach
Surgeon accesses the patient’s spinal column from the front of the spine and is generally used in cases where the curvature is in the mid- to low-back (thoracolumbar) portion of the spine and in instances where the curve is especially severe. This approach also is frequently used for corrective scoliosis surgery in adults, whose curves tend to be more rigid than those in children.
How Is An Anterior Spinal Fusion Performed? For an anterior spinal fusion, you’ll be positioned on the operating table and sedated under general anesthesia. During this procedure, which usually takes several hours, your surgeon will:
- Depending on the location of the curve, make an incision along the side of the body, over the chest wall or abdomen.
- Remove a rib for spinal access and, if necessary for spinal access, deflate a lung and/or temporarily detach the diaphragm (the thin muscular membrane that separates the thoracic and abdominal cavities and also aids breathing).
- Remove disc material from between the vertebra involved in the curve, to increase curve flexibility and provide sufficient surface area for spinal fusion.
- Attach instrumentation to the vertebrae. This involves:
- Establishing “connection points” with screws and other devices.
- Attaching a specially contoured rod to aid in correction and stabilization.
- Insert bone graft or bone graft substitute to promote fusion.
- Complete a final tightening of the instrumentation.
- Close the incision.
Advantages of an Anterior Approach? One of the advantages of an anterior approach to scoliosis surgery in the appropriate curves is that fewer vertebral bodies may need to be fused. This helps preserve motion, because when vertebrae are fused they become “one unit,” so to speak, and inflexible. Removing disc material also may allow for better curve correction and a more favorable physical appearance.
Posterior Approach
Surgeon accesses and operates on the patient’s spine from the back and is most commonly used technique for surgically treating scoliosis in children and adolescents. A spinal fusion involves placing bone graft or bone graft substitute in the spaces between each vertebra and then fastening instrumentation to the vertebrae to be fused. This serves as an “internal cast” to help realign and stabilize the vertebrae while the graft heals and the bones properly fuse For a posterior spinal fusion, you’ll be positioned on your stomach on the operating table and sedated under general anesthesia. The procedure typically takes several hours. During surgery, your surgeon:
- Makes an incision in your back to access the vertebrae involved in the spinal curve.
- Retracts or separates the spinal muscles to allow access to the vertebrae.
- Attaches instrumentation to the vertebrae. This involves:
- Establishing “connection points” with hooks, screws, wires and other devices.
- Attaching a specially contoured rod to aid in correction and stabilization.
- Inserts bone graft or bone graft substitute to promote fusion.
- Completes a final tightening of the instrumentation.
- Closes the incision.
Anterior and Posterior
Anterior and posterior surgery is generally recommended for curves that are very severe, stiff, or when you have failed previous attempts at fusion. Anterior and posterior surgery requires that the surgeon will first approach your spinal column from the front. In order to do this, the surgeon will usually make an incision on your side. The surgeon will then remove the disc material from between the vertebrae in the most severe part of your curve to make your curve more flexible and facilitate fusion.
After the anterior part of the procedure is completed, the wound is closed and you are then positioned for the “back” or posterior part of the procedure. The deformity is then corrected with placement of spinal instrumentation in your back followed by a posterior fusion as described above. Some surgeons may choose to place a drain into the wound after the surgery to protect the incision. Patients wake up in their hospital bed lying on their back. Most patients who have had anterior and posterior surgery will require care in the Intensive Care Unit after surgery.
Minimally Invasive Scoliosis Surgery
Minimally Invasive Scoliosis Surgery employs less invasive surgical techniques, such as muscle dilation, that enable surgeons to perform fusion surgery through several small incisions rather than one long one. Endoscopic surgery is not appropriate for everyone or every curve including but not limited to lumbar (lower back) and thoracolumbar (mid-lower back) curves. Only your doctor can determine whether you are a suitable candidate for this type of procedure.
Your recovery period will vary, depending on your procedure and your body’s ability to heal and firmly fuse the vertebrae together.
Work closely with your doctor to determine the appropriate recovery plan for you.
All treatment and outcome results are specific to the individual patient.
