What is scoliosis and why is scoliosis surgery required?
The spine is the backbone of the body. It naturally curves a little. This allows us to walk, move and balance ourselves properly. But some people have a spine that curves too much to one side. This condition is called scoliosis. In most cases, especially in children and adolescents, the cause of scoliosis is unknown and scoliosis is referred to as idiopathic scoliosis.
Scoliosis usually has no symptoms. In severe cases, the body looks asymmetrical with uneven hips or shoulders. Severe scoliosis may also cause backache and could contribute to other health problems.
To diagnose scoliosis, your doctor will do a physical examination. The doctor will also order some diagnostic tests such as X-rays, a Computed Tomography (CT) scan and/or Magnetic Resonance Imaging (MRI) to determine the actual curving of the spine. If your doctor considers that your curve is mild, he/she may prescribe back braces to prevent further curving. However, if the curve is more than 45 degrees, your doctor may recommend corrective spinal surgery.
What is the anterior-posterior approach for scoliosis surgery?
The goal of scoliosis surgery is to both reduce the abnormal curve in the spine and to prevent it from progressing further and getting worse. To achieve this, a spinal fusion is performed to fuse the vertebrae in the curve to be corrected. This involves placing bone graft or bone graft substitute in the inter-vertebral space between the two vertebrae. Instrumentation such as rods and screws are also used to realign and stabilize the vertebrae until the graft heals and fuses the two vertebrae together.
There are several approaches for scoliosis surgery. The choice of approach depends on a number of factors such as the type of scoliosis, location of the curvature of spine, ease of approach to the area of the curve and the preference of the surgeon.
Anterior-posterior approach is also called front and back spinal surgery. This approach is usually recommended for very severe and stiff curves. Sometimes, it is also used to correct previous failed attempts. In this approach, the spine is first accessed from the front or anterior side of the body through an incision on the side followed by an incision on the back (posterior side of the body).
How is an anterior-posterior scoliosis surgery performed?
An anterior-posterior scoliosis surgery is performed under general anesthesia.
- First an incision is made on the side and the spine is accessed through this incision from the front side of the body.
- To reach the spine, a rib is often removed which may be used as a source of bone graft for spinal fusion.
- Disc material is removed from between the vertebrae involved in the most severe part of your curve. Removal of the disc material improves the flexibility of the curve and also provides a large surface area for spinal fusion.
- The bony surface between the vertebral bodies is roughened and bone graft or bone graft substitute is packed into the space between the vertebral bodies to promote fusion and then the anterior incision is closed.
- You are then positioned on your stomach for the posterior part of the procedure.
- An incision is made down the middle of the back and the muscles are stripped off the spine to reach the bony elements of the spine.
- Instrumentation is used to reduce the curvature of the spine. This involves placing screws, hooks, wires or other devices at each vertebral level involved in the curve. A specially contoured rod is then attached to these connection points at each level and correction is performed.
- Once all the implants are placed securely, a final tightening is done and the incision is closed. Sometimes, a drain may be placed into the wound to protect the incision.
The whole procedure usually takes several hours.
How long does the recovery take?
The spine looks much straighter soon after the surgery, but some curve will still be there. Spinal bones take a minimum 3 months to fuse together. However, complete fusion usually takes one to two years.
What are the potential risks and complications of the procedure?
Scoliosis surgery is a major surgery. All attempts are made to reduce the chances of any risks or complications of this surgery. Still, complications may occur in a few patients. Complications of scoliosis surgery may include paraplegia, excessive blood loss, infection and failure of the spine to fuse. Rarely, cerebrospinal fluid leakage or instrumentation problem such as breaking of rods or dislodging of hooks and screws may also occur.