What Is Scoliosis Surgery?

Scoliosis is a disorder in which the spine, which is normally straight, has one or more lateral curves. These curves can range in severity from mild and asymptomatic to being severe enough to compromise organ function and cause visible skeletal deformities. Treatments for scoliosis include exercises and physical therapy, electrical stimulation, bracing and, in more severe cases, surgery.

Indications for Surgery

The vast majority of scoliosis patients are not candidates for surgical intervention. In general, doctors will recommend surgery whenever a curve measures greater than 40 degrees, when the patient is experiencing severe symptoms such as back and muscle pain or nerve damage, and in cases where the curvature is compromising organ function. Because severe scoliosis is progressive, patients with one or more curves of 40 degrees plus can expect them to worsen by one to two degrees per year indefinitely, which is another reason that surgery is generally indicated in such cases. Additionally, when moderate to severe scoliosis does not respond to less invasive treatments such as bracing, surgery may be considered.

Goal of Surgery

The goal of surgery is to halt the progression of the curvature and to make the spine balanced. Surgery does not completely straighten the spine, as such an extreme torsion from the present state of the spinal column can compromise the spinal cord. Rather, the surgeon aims to stabilize the curve or curves as they are, while maintaining spinal flexibility for the patient. This is achieved through the correction and stabilization of the curves via various techniques and implants.

Types of Surgery

Surgeons may approach scoliosis surgery through either a posterior or anterior incision. This decision is based primarily upon the location of the curve that is being treated. While most treatments are conducted posteriorly (with an incision down the back), dysfunction in the low lumbar region and pelvis area are often treated via anterior incisions (an incision that goes through the front of the body). In some cases, surgeons can opt to use an endoscope to perform the procedure.

Surgical Procedure

During the procedure, the spine is straightened (to some degree, as determined by the surgeon) and stabilized through the use of both implants and fusion. Implants are medical grade devices that stay in the patient permanently, and may include hooks, rods, wires and screws or some combination of the above. In conjunction with the implant, the surgeon will perform a bone graft and fusion, in which grafted bone (donor or taken from the patient) is placed within and around both the implant and the spine. This fused bone eventually grows around the device and provides additional stability.

Recovery

In most cases, patients are released within one week of surgery, but recovery can be a long process as the fusion must stabilize and the patient must regain muscular strength. During the first several months after surgery, activities are limited to those that are necessary for daily living. Within one year, a patient can expect to resume all normal activities including strenuous athletic activities.

Resources

• Guide to Scoliosis