Surgery for Scoliosis Patients

spinal surgery

Story at-a-glance -

  • Scoliosis patients who require surgery often have deformities that are continuing to worsen. The surgery can help prevent the curve from worsening
  • Before undergoing a surgery for scoliosis, take note that this should only be done as a last resort, especially if the curve of the spine is severely affecting the patient

The type of surgery that a scoliosis patient may undergo can be determined by the cause of scoliosis. However, the location of the curve (thoracic, thoracolumbar or lumbar), amount of curves (single, double or triple curves), rotation present in the spine, curve of the curve and patient’s condition (the scoliosis diagnosis) are other factors that have to be considered.1 There are three main goals of a surgery for scoliosis:2

  • Stop curve progression: Scoliosis patients who require surgery often have deformities that are continuing to worsen. The surgery can help prevent the curve from worsening.
  • Reduce deformity: Surgery can de-rotate the abnormal spine twisting and correct the lateral curve by about 50 to 70 percent, depending on the amount of flexibility left in the spine. Eventually, these changes can help the patient stand up straighter and reduce the rib bump in the back.
  • Maintain trunk balance: When it comes to changes made to the spine’s positioning, the surgeon in charge must take into account the overall trunk balance, and try to maintain as much of the spine’s natural front/back (lordosis/kyphosis) curvature while keeping the legs and hips as even as possible.

Before undergoing a surgery for scoliosis, take note that this should only be done as a last resort, especially if the curve of the spine is severely affecting the patient. If you wish to treat back pain caused by scoliosis, try utilizing natural remedies first instead of going under the knife.

Candidates for Scoliosis Surgery

Patients diagnosed with these types of scoliosis may be recommended surgery:3

  • Idiopathic scoliosis: Children and adolescents with idiopathic scoliosis may undergo a procedure if their skeletons have matured and they have a curve greater than 45 degrees. Growing children whose curves are above 40 degrees may be candidates too, although there is still debate on whether all children with 40-degree curves should have surgery.
  • Neuromuscular scoliosis caused by cerebral palsy and meningomyelocoele: Surgery is often performed if the curve reaches 40 degrees or more in patients younger than 15 years old. However, patients with feeding problems, are malnourished or have respiratory difficulties due to the scoliosis may have an increased surgical risk and a higher risk for bleeding complications.
  • Congenital scoliosis: There is a higher chance for success when a surgery is done at a younger age, although children with congenital scoliosis have a higher risk of having a neurological injury during the surgery.
  • Adult scoliosis: Adults may undergo a surgery, but because of an increased risk for complications, there is reluctance among this particular age group.

There are cases when children must require a team approach to lower their risks for complications.

Types of Surgery for Scoliosis Patients:

A typical scoliosis surgery procedure for a child will involve these steps:4

  1. Insertion of bone grafts: Two or more vertebrae, or spine bones, are connected with new bone grafts. In some cases, metal rods, hooks, screws or wires are utilized to hold a portion of the spine straight while the bone heals.
  2. Patient is placed in intensive care: A usual operation lasts four to eight hours. Afterwards, the patient is transferred to the intensive care unit (ICU), where he or she will be given intravenous fluid and pain relief. In most cases, the patient can leave the ICU within 24 hours, but they have to remain in the hospital for seven to 10 days.

Surgeries for scoliosis utilize these approaches:5,6

Posterior approach: Considered the most common type of scoliosis surgery, the posterior approach is performed with the patient lying face-down, and the surgeon reaches the surgical area by “opening” the patient’s back.

Anterior approach: Surgeons make an incision on the patient that follows the bottom ribs, ending in a north-south direction above the navel. This allows the surgeon to access the lower spine very easily.

In some cases, the surgeon can also perform the operation through the chest wall (called a thoracotomy), by making an incision in the chest, deflating the lung and removing a rib to reach the spine. The removed rib can be used during the procedure as a strut to support the spine and may also be repositioned within the patient until it’s used for bone grafting during fusion.

Combined posterior-anterior approach: The anterior approach is used first to allow correction of the problems, while the posterior approach is utilized for the fusion part of the operation. Combining these two approaches can lead to a very long and complex surgery.

Video-Assisted Thoracoscopic Surgery (VATS): This involves video-assisted anterior approach and spinal instrumentation (developed recently). There are two caveats for VATS. The first is that it can be complicated and only a few surgeons are trained to perform it, and the second is that VATS is used only for patients with single curves in the upper back, or with a curve in the upper back and a compensating curve in the lower back.

Common types of scoliosis surgery for both children and older patients include:7,8

For Children For Adults
  • Spinal fusion
  • In-situ fusion
  • Spinal fusion with instrumentation
  • Hemivertebra removal
  • Traditional growing rods
  • Magnetically controlled growing rods
  • Growth-guided devices
  • Vertebral body tethering or fusionless scoliosis correction
  • Thoracoplasty (rib resection or removal)
  • Osteotomies (bone removal)
  • Hemivertebrae excision (partial or complete removal of a vertebra)
  • Kyphosis/flatback surgery
  • Vertebral column resection

In severe cases, scoliosis can progress over time. Because of this, a physician or doctor can recommend a spinal fusion to help reduce the spinal curve and prevent it from worsening. However, it’s only recommended to a patient if the benefits outweigh the risks. Rod displacement, pseudoarthritis, infection and nerve damage have all been linked to a spinal fusion.9

What to Expect After the Surgery

According to the University of California-San Francisco Medical Center, the patient must not go to school or work, or participate in organized activity in the first two weeks after the operation to physically and mentally heal. The wound dressing shouldn’t be disturbed too, so the patient must take sponge baths only until the follow-up appointment in two weeks. During the follow-up appointment, the surgeon will inspect the wound and change the dressing or bandage.10

Every six months, the patient must return to the hospital to have the rods lengthened. This is usually an outpatient procedure. Once the spine has grown, the rods can be surgically removed.11

Recovery time after scoliosis surgery depends on the patient’s age. Children can usually go back to school within four to six weeks, and participate in sports roughly a year after a surgery. The patient may also need to wear a back brace for around six months to support the spine.

Older patients, especially those who are already frail, may need to stay in a rehabilitation unit after hospital release to help with recovery.12 These people may also need constant care and attention for around six to eight weeks. During the course of the year, the patient may notice that he or she can already perform these activities:13,14

  • Three to six months after surgery: Patients can return to work and do light exercises. Activities must be limited to “activities of daily living,” such as walking, bending and personal care. No strenuous physical activity, running or jumping and lifting heavy items (nothing heavier than a dinner plate) are allowed.
  • Six to eight months: A physical exam will be performed after six months, including x-rays. If results are positive, more activity, such as swimming, can be allowed.
  • Eight to 10 months: At around eight months, the patient can start performing “closed chain kinetic exercises,” wherein the foot is planted or fixed in place as the lower limb moves. Bicycling is an example, where the foot is on a pedal as the lower limb rotates.
  • Ten to 12 months: Running, jumping and solo sports may be allowed. At 12 months, the patient can visit the surgeon for a post-surgery appointment and undergo x-rays. If all is well, the patient can be allowed to return to unrestricted activities.

Do take note that this timetable is a rough estimate. There is actually no set timeframe for recovery after scoliosis surgery because the procedure can affect people in different ways. No patient’s experience is the same as another’s.

MORE ABOUT SCOLIOSIS

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What is Scoliosis?

Types of Scoliosis

Severe Scoliosis

Scoliosis Symptoms

Dealing with Scoliosis-Related Pain

Scoliosis Causes

Scoliosis Side Effects

Scoliosis Treatment

Scoliosis Back Braces

Yoga for Scoliosis

Exercises for Scoliosis Patients

Scoliosis Surgeries

Scoliosis Prevention

Diet for Scoliosis Patients

Scoliosis FAQ



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