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Scoliosis Surgery

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.

Unlike back braces, which do not correct spinal curves already present, surgery

can correct curvature by about 50%. Furthermore, surgery prevents further

progression of the curve.

There are several approaches to scoliosis surgery, but all use 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 with existing bone.

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.

Scoliosis (from Greek: skolios "crooked")[1] is a medical condition in

which a person'sspine is curved from side to side. Although it is a complex three-

dimensional deformity, on an X-ray, viewed from the rear, the spine of an

individual with scoliosis may look more like an "S" or a "C" than a straight line.Scoliosis is typically classified as eithercongenital (caused by vertebral

anomalies present at birth), idiopathic (cause unknown, subclassified as infantile,

juvenile, adolescent, or adult, according to when onset occurred),

orneuromuscular(having developed as a secondary symptom of another

condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or
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physical trauma. A lesser known underlying cause of scoliosis could be attributed

to a condition called Chiari malformation.

Recent longitudinal studies reveal that the most common form of the

condition, late-onset idiopathic scoliosis, is physiologically harmless and self-

limiting even without treatment.[2][3] The rarer forms of scoliosis pose risks of

complications.
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Anatomy of ScoliosisTo understand scoliosis, which causes the spine to curve to the left or right, you first

need to understand what a normal spine looks like. There are 4 regions in your spine:

Cervical Spine: This is your neck, which begins at the base of your skull. Itcontains 7 small bones (vertebrae), which doctors label C1 to C7 (the "C" means

cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to

the skull, while C7 is closest to the chest.

Thoracic Spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the

"T" means thoracic). Vertebrae in your thoracic spine connect to your ribs,

making this part of your spine relatively stiff and stable. Your thoracic spine

doesn't move as much as the other regions of your spine, like the cervical spine.

Lumbar Spine: In your low back, you have 5 vertebrae that are labeled L1 to L5

(the "L" means lumbar). These vertebrae are your largest and strongest

vertebrae, responsible for carrying a lot of your body's weight. The lumbarvertebrae are also your last "true" vertebrae; down from this region, your

vertebrae are fused. In fact, L5 may even be fused with part of your sacrum.

Sacrum and Coccyx: The sacrum has 5 vertebrae that usually fuse by

adulthood to form 1 bone; the coccyxmost commonly known as your tail bone

has 4 (but sometimes 5) fused vertebrae.

From behind, the normal spine appears straight. However, when viewed from the side,

you'll see that the spine has both inward and outward curves. These curves help our

back carry our weight and are also important for flexibility.

There are 2 types of curves in your spine: kyphosis and lordosis. You can see those

from the side view. Kyphosis means the spine curves inward; lordosis means the spine

curves outward. There are 2 kyphotic and 2 lordotic spinal curves in a normal spine.

Your neck (cervical spine) and low back (lumbar spine) have a lordotic curve. Your mid

back (thoracic spine) and pelvis (sacrum) have a kyphotic curve.
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Pathophysiology of Scoliosis

Scoliosis is an abnormal sideways curvature of the spine that is typically found

in children and adolescents. In most cases, scoliosis is painless. However, it can

become gradually more severe if left untreated, resulting in chronic back pain.

In young children, severe cases can cause deformities, impair development and

be life-threatening.

In most cases, scoliosis is painless and develops gradually. It often worsens

during growth spurts in children and teens. Scoliosis patients who wear a back

brace over an extended period of time can usually prevent further curvature of

the spine.

The cause of most cases of scoliosis cases is unknown (idiopathic). Suspected

causes of scoliosis include connective tissue disorders, muscle

disorders, hormonal imbalance and abnormality of the nervous system. Spinal

cord and brainstem abnormalities may also contribute toscoliosis. The

condition can also be hereditary.

Physicians classify the causes of scoliosis curves into one of two categories:

Nonstructural scoliosis. Also known as functional scoliosis, this involvesa spine that is structurally normal yet appears curved. This is a

temporary curve that changes, and is caused by an underlying condition

such as difference in leg length, muscle spasms or inflammatory

conditions such as appendicitis. Physicians usually treat this type

ofscoliosis by addressing the underlying condition. The term

nonstructural scoliosis has also been used to describe cases involving a

sidetoside curvature.

Structural scoliosis. This is a fixed curve that is treated individuallyaccording to its cause. Some cases of structural scoliosis are the result of

disease, such as the inherited connective tissue disorder known

asMarfans syndrome. In other cases, the curve occurs on its own. Other

causes include neuromuscular diseases (such as cerebral palsy,

poliomyelitis or muscular dystrophy), birth defects, injury, infection,

tumors, metabolic diseases, rheumatic diseases or unknown factors. The


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term structuralscoliosis has also been used to describe cases involving a

twisting of the spine in three dimensions rather than a sideways

curvature.

Certain factors are known to increase the risk for scoliosis, as well as the risk

that the disorder will become more severe. These include:

Sex. Girls ages 3 and older are more likely to have scoliosis than boys.

In contrast, boys are more likely to have the disorder than girls before

age 3.

Age. The younger a child is when scoliosis begins, the more severe the

condition is likely to become.

Angle of the curve. The greater that angle of curve, the increased

likelihood that the condition will get worse.

Location. Curves in the middle to lower spine are less likely to worsen

than those of the upper spine.

Spinal problems at birth. Children who are born with scoliosis

(congential scoliosis) may experience rapid worsening of the curve.


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PROCEDURE

Two Approaches to Scoliosis Surgery

There are two general approaches to the scoliosis surgery a posterior

approach (from the back of the spine) and an anterior approach (from the front of

the spine). Specific surgery is recommended based on the type and location of

the curve.

Article continues below

1. Scoliosis Surgery from the Back (Posterior SurgicalApproach)

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

After making the incision, the muscles are stripped 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 patients own bone, taken from the patients

hip, or cadaver bone), inciting a reaction in which the bones in the spine

begin fusing together

The bones continue to fuse after surgery is completed. The fusion processusually takes about 3 to 6 months, and can continue for up to 12 months

For patients who have a severe deformity and/or those who have a very rigid

curvature, another procedure may be required prior to this surgery. A surgeon

may recommend an anterior release of the disc space (removal of the disc from

the front), which involves approaching the front of the spine either through an

open incision or with a scope (thoracoscopic technique) and releasing the disc

space.

After the discs at the appropriate levels of the spine have been removed, bone

(either the patient's own bone and/or cadaver bone) is added to the disc space toallow it to fuse together.

Removing the discs allows for a better reduction of the spine and also results in a

better fusion. These two factors are especially important if the patient is a young

child (10 to 12 years old) and has a lot of skeletal growth left.

Without the anterior release procedure, the anterior column (the part of the spine

facing the front of the body) can continue to grow, eventually twisting around the
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fused, non-growing posterior spinal column, forming a new scoliosis curve (called

"crankshafting"). Fusing the spine anteriorly prevents this process.

In This Article:

Scoliosis: What You Need to Know

Scoliosis Types Scoliosis Symptoms

Scoliosis Diagnosis

Scoliosis Treatment

Scoliosis Surgery

Scoliosis Surgery: Potential Risks and Postoperative Care

Scoliosis Video: What is Scoliosis?

2. Scoliosis Surgery from the Front (Anterior SurgicalApproach)

For curves that are mainly at the thoracolumbar junction (T12-L1), the scoliosissurgery can be done entirely as an anterior approach.

This approach to scoliosis surgery requires an open incision and the

removal of a rib (usually on the left side). Through this approach, the

diaphragm can be released from the chest wall and spine, and excellent

exposure can be obtained for the thoracic and lumbar spinal vertebral

bodies.

The discs are removed to loosen up the spine.

Screws are placed in the vertebral bodies and rods are put in place to

reduce the curvature. Bone is added to the disc space (either the patients own bone, taken from

the patients hip, or cadaver bone), to allow the spine to begin to fuse

together.

This fusion process usually takes about 3 to 6 months, and can continue

for up to 12 months.

If this surgery is applicable because of the type of curvature, the anterior

approach to scoliosis surgery has several advantages over the posterior

approach.

Not as many lumbar vertebral bodies will need to be fused and some

additional motion segments can be preserved

Saving motion segments is especially important for lower back curves

(lumbar spine), because if the fusion goes below L3 there is a higher risk of

later back pain and arthritis

Saving lumbar motion segments also helps prevent loading all the stress

on just a few motion segments
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This approach can sometimes allow for a better reduction of the curve and

a more favorable cosmetic result.

The major disadvantage of the anterior approach is that it can only be done for

thoracolumbar curves, and most scoliotic curves are in the thoracic spine.

scoliosis surgery iannn

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