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Spine Surgery Guide

Surgery for Scoliosis

Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Scoliosis surgery is designed to reduce the patients curvature and fuse the spine to prevent any further progression of the deformity.

Severe curvatures (greater than 50 degrees) are more likely to progress in adulthood. If a curve is allowed to progress to 70 - 90 degrees, it will not only result in a very disfiguring deformity, but will start to result in cardiopulmonary compromise. This happens because the curve in the spine rotates the chest and closes down the space available for the lungs and heart.

Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.

There are two general approaches to the scoliosis surgery – a posterior approach (from the back of the spine) or an anterior approach (from the front of the spine).

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Scoliosis surgery from the back (posterior surgical approach)

This approach to scoliosis surgery is done through a long incision on the back of the spine (the incision goes the entire length of the thoracic spine)

  • After making the incision, the muscles are then stripped up off the spine to allow the surgeon access to the bony elements in the spine
  • The spine is then instrumented (screws are inserted) and the rods are used to reduce the amount of the curvature
  • Bone is then added (either the patient’s own bone, taken from the patient’s hip, or cadaver bone), which in turn incites a reaction that results in the spine fusing together.
  • This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.

Potential risks and complications with scoliosis surgery

The most concerning risk with scoliosis surgery is paraplegia. It is very rare (about 1 in 1,000 to 1 in 10,000 chance) but is a devastating complication. To help manage this risk, the spinal cord can be monitored during surgery through one of two methods:

  • Somatosensory Evoked Potentials (SSEP's). This test involves small electrical impulses that are given in the legs and then read in the brain. If there is the development of slowing of the signals during surgery this can indicate compromise to the spinal cord or its blood supply. Another way to monitor the cord is with Motor Evoked Potentials (MEP's), and often both are used throughout a surgery.
  • Stagnara wake up test. This test involves waking the patient during the surgery and asking them to move their feet. The patient does not feel any pain during this procedure and will not remember it afterwards.

If either of these tests indicates spinal cord compromise, the rods can be cut out and the surgery abandoned. Fortunately, this situation is extremely uncommon, and many procedures can be rescheduled if the patient is found to be neurologically intact after the surgery. Another risk with scoliosis surgery is excessive blood loss. There is a lot of muscle stripping and exposed area during the surgery.

With proper technique the blood loss can usually be kept to a reasonable amount and blood transfusions are rarely needed. As a precaution, many surgeons will ask the patient to donate his or her own blood prior to surgery (autologous blood donation), which can then be given back to the patient after the surgery. Also, during scoliosis surgery the patient's blood can be collected and transfused back to the patient.

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This information is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient.
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