The vertebral column in our body is aligned in a straight-line with certain natural curves to it. These curves are responsible for not only maintaining our upright posture but also to absorb the shock that we experience when walking or running.
Unfortunately, sometimes the spine is misshapen and misaligned.
This results in an abnormal curvature of the spine. A condition where the spine is shaped as an S or C when viewed from behind is called scoliosis.
As a clinical condition, scoliosis is common in girls when compared to boys. It becomes evident after the age of 10. Many cases have a positive family history of the condition. Treatment of this condition is primarily through physical therapy and scoliosis surgery. In this article, we shall take a brief look at scoliosis surgery and how it is performed.
The video below describes scoliosis as a clinical condition:
When is scoliosis surgery performed?
Scoliosis surgery is recommended for adolescents who suffer from scoliosis that affects the spine by curving it to an excess of 40 to 45° in an abnormal sideward direction. It is utilised in patients who have not received any benefit from back braces all find that their spinal deformity is impacting their daily life significantly.
Scoliosis surgery is offered to younger individuals as once they get older, the bones are fused and the spine cannot be corrected. During the surgery, rods are inserted into the spinal bones that will help all of them in the required position. As the patient gets older, the bones will then become firmer and will fuse with the rods, keeping the spine in position.
Types of scoliosis surgery
Scoliosis surgery can be performed through two different approaches. In one approach, the spine is accessed through the back by making a long incision along the vertebral column. This is known as the posterior surgical approach. The other approach is known as the anterior surgical approach where the spinal column is accessed through the front of the body.
The general principles behind scoliosis surgery remain the same. Once consent is obtained from the patient or their families, the area where the incision is to be made is cleaned with antiseptic solution and covered in sterile drapes. After the incision is made, nearby tissues are dissected out in a manner so as to expose the vertebral bones.
The bones that are abnormally positioned are identified and using special instruments, they are positioned ‘normally’ using screws and rods.
Once these have been inserted, fresh bone tissue that has been obtained from the hip is inserted into the small gaps that exist between the rods and the vertebral bones. This stimulates the formation of new bone which ultimately fuses to the rods. In some cases, the intervertebral discs are also removed to allow for better positioning of the spine. This also aids in achieving better results, particularly if the patient is very young.
While the above describes the posterior approach, the anterior approach is not significantly different other than the area through which the spine is accessed. The anterior approach does have certain advantages over the posterior approach in that it helps preserve a greater degree of spinal movement as fewer vertebra will need fusing.
By preserving motion, the chances of developing arthritis and back pain is reduced in the future. In addition, it is believed that the anterior approach provides a better cosmetic result than the posterior approach. The main disadvantage of the anterior approach is that it can only access the spine that exists in the thoracic and lower back area and not the cervical spine.
This video demonstrates scoliosis surgery:
Scoliosis surgery can take a few hours to perform. Once concluded, the patient is observed for a period of time and is subsequently discharged home. Patients can start to mobilise around 2 to 3 days following the procedure. In hospital stay can range between 5 to 7 days. It can take anywhere up to 6 months for complete fusion of the spine to occur with the rods inserted. Patients will require extensive physical therapy to help them recover following the surgery. Children can often get back to school a month following the procedure.
Post operatively, patients need to ensure that they do not twist their spine or bend down for the first few weeks. Heavy lifting is not recommended. Patients will be constantly reviewed in the outpatient department and x-rays will be performed to ensure that the rods are in place and the spine is healing as required.
Risks of scoliosis surgery
One of the most worrying risks of scoliosis surgery is paralysis of the arms and legs. This is called paraplegia. It is a rare complication but if it does occur can be life changing. It is for this reason that during scoliosis surgery, the conduction of electrical impulses through the nerve fibres within the spinal-cord is constantly monitored. This way, any damage to the spinal-cord is reflected as a change in electrical conduction and appropriate steps can be taken to prevent damage.
Another risk associated with scoliosis surgery is the loss of large amounts of blood. As the surgery requires exposure of the spinal-cord by moving tissues around, it is not uncommon for bleeding to occur in patients who require a blood transfusion. However, the chance of this occurring is a rare, especially when the surgery is performed by experienced surgeons.
Other complications include dislodging of the screws and rods, leakage of cerebral spinal fluid and infection. In less than 5% of cases, the vertebral bones fail to fuse with the rods.
Benefits of scoliosis surgery
By correcting scoliosis, patients will find that they are able to do a lot more activities that they enjoy. In particular, children can enjoy the sport that they love and can lead completely normal and healthy lives. Female patients can become pregnant in the future and deliver babies normally.
The video below describes a patient’s experience following scoliosis surgery:
Scoliosis surgery is a commonly performed procedure to correct scoliosis in children. It consists of insertion of screws and rods into the spine which over time fuse of the vertebral bones and maintain the upright straight posture. Risks are a few but the long-term benefits are many.
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