Anterior Cervical Discectomy & Fusion :: Posterior Cervical Laminectomy :: Lumbar Laminectomy :: Lumbar Microdiscectomy :: Lumbar Decompression & Fusion :: Fusion for Scoliosis :: Pedicle Subtraction Osteotomy
Scoliosis is the abnormal curvature of spine giving the spine an “S” or “C” shape in a skeletally mature person. Larger curves cause discomfort while the smaller curves do not cause any problems.
In some patients simple life style modifications such as improved nutrition, smoking cessation and regular exercise may be sufficient for the management of scoliosis. A few patients may respond to non-surgical methods such as analgesics and anti-inflammatory medications, braces, spinal injections, and physical therapy.
Surgery is recommended for patients who fail to respond to non-surgical treatment or the curvature progresses and becomes greater than 45-degrees, or is a cause of cardiopulmonary complications.
Surgery is an option for individuals with severe scoliosis to stop the curve from getting worse. The surgery repairs the abnormal curvature of the spine. There are different surgical approaches to repair the deformity, and the choice of the approach to the spine is based on the type of scoliosis, location of the curvature of the spine, ease of approach to the area of the curve and the preference of the surgeon.
- Anterior approach – It is the procedure in which the surgeon will approach the spinal column from the front of the spine rather than through the back. The incision is made on the patient’s side, over the chest wall or lower down along the abdomen, depending on the part of the spine that requires correction. The lung is deflated and a rib is removed in order to reach the spine. After the exposure of the spinal column, the disc material between the vertebra involved in the curve is removed. Screws are placed at each vertebral level involved in the curve, and these screws are attached to a single or double rod at each level. After instrumentation a fusion is performed, the bony surface between the vertebral bodies is roughened and bone graft is placed. A combination of compression along the rod, and rotation of the rod will correct the spine deformity. The incision is closed and dressed.
- Posterior approach- It is the most traditional approach and the approach is made through the patient’s back while the patient lies on his or her stomach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina, and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod that is bent and contoured into a more normal alignment for the spine is attached and the correction is performed. After the final tightening, the incision is closed and dressed.
- Anterior and posterior approach – This approach is used in cases where the curve is stiff and severe. The first approach to spinal column is made from the front. The incision is made on the patient’s side, over the chest wall or lower down along the abdomen. Disc material between the vertebrae is removed. This procedure requires removal of a rib, which is later used for bone grafting.
After the anterior procedure, the wound is closed and the patient is positioned for the posterior approach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina, and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod that is bent and contoured into a more normal alignment for the spine is attached and the correction is performed. After the final tightening, the incision is closed and dressed.
Possible complications after scoliosis repair surgery may include:
- Nerve damage causing muscle weakness
- Respiratory or lung problems causing difficulty in breathing
- Spine Infection
- Failure of the bone to join together
- Blood loss requiring transfusion
- Blockage of the intestine may occur
- Gallstones may occur
- Movement of the metal hooks placed in the spine
- Pseudarthrosis, a painful condition occurring as a result of non-healing of the bone effusion, and a false joint grows at the site
- Blood clot formation in the legs: is rare but dangerous if they dislodge and travel up to the lungs
- Pain at the bone graft site
Physical therapy is advised after surgery to help the spine grow normally. Physiotherapists evaluate the posture, muscle strength, and flexibility and then design exercise program suitable for patient that helps to control pain and improve the disability.