Scoliosis is a common spinal disorder that may cause functional impairment and significant physical deformities in advanced cases. Scoliosis surgery is an effective treatment option for patients who do not respond to conservative methods, aiming to correct spinal curvature and stabilize the vertebrae. Advancements in techniques and procedures have significantly improved the outcomes and safety of scoliosis surgery. This article covers key aspects of scoliosis surgery, including indications for intervention, surgical approaches, and potential complications.
What is scoliosis, and when does surgery become a necessary treatment?
Scoliosis is a spinal condition characterized by an abnormal lateral curvature, typically diagnosed after the age of 10 or during early adolescence. The curvature may develop in any part of the spine, bending to the right or left in a “C” or “S” shape. While the exact cause of most childhood scoliosis cases remains unclear, the majority are mild and do not require treatment. However, some curvatures may worsen as the child grows, potentially causing pain or breathing difficulties due to excessive pressure on the lungs.
Doctors closely monitor children with mild scoliosis throughout their development with routine check-ups, including physical examinations and radiographs, to track curve progression. While many cases do not require treatment, some may benefit from bracing to prevent worsening, whereas severe cases may necessitate scoliosis surgery to correct the deformity and stabilize the spine.
Types of scoliosis
Scoliosis includes various types that differ based on their causes and onset. Idiopathic scoliosis is the most prevalent type, accounting for nearly 80% of cases, and typically develops during adolescence, although it may also arise in early childhood or infancy. It is termed “idiopathic” due to the absence of a identified cause, with research suggesting a potential genetic link alongside other contributing factors that are currently under investigation. Idiopathic scoliosis is classified by age at diagnosis into pediatric scoliosis (under 3 years), juvenile scoliosis (4 to 10 years), adolescent scoliosis (11 to 18 years), and adult idiopathic scoliosis (diagnosed after full skeletal maturity at 18 years or older).
Congenital scoliosis is a rare form resulting from vertebral anomalies that develop in the uterus, often detected at birth or early childhood. These abnormalities affect spinal structure and frequently necessitate scoliosis surgery to correct the curvature. Neuromuscular scoliosis, on the other hand, arises in individuals with neurological or muscular conditions such as cerebral palsy, muscular dystrophy, or spina bifida. It stems from weakened spinal support muscles or loss of muscular balance and tends to worsen, particularly in non-ambulatory patients.
Scoliosis can also manifest in adulthood as idiopathic adult scoliosis, which may have existed since adolescence but remained undetected, or as degenerative scoliosis, commonly found in the lumbar spine of individuals over 65 years old. Degenerative scoliosis is often associated with spinal stenosis, a condition in which the narrowing of the spinal canal puts pressure on the nerves.
In rare instances, scoliosis can result from tumors or lesions within the spine, particularly when accompanied by pain or neurological symptoms, such as numbness or limb weakness. In such cases, specialists use advanced imaging techniques, such as magnetic resonance imaging, to rule out serious underlying causes of the curvature.
When does surgery become a necessary treatment?
When the curvature of the spine exceeds 45 to 50 degrees, it is more likely to worsen even after skeletal growth is complete, which can lead to pronounced deformities in posture and may adversely affect lung function. In such cases, scoliosis surgery is usually recommended to correct the curve and prevent its progression.
In cases where the curvature is between 40 and 50 degrees in growing children, these cases are considered a gray area, where the surgical decision is not entirely clear, and the recommendation for surgical treatment depends on multiple factors, such as the pattern of curvature development, the child’s growth rate, and the accompanying symptoms. It is important to discuss these aspects in detail with your surgeon to determine the most appropriate option for each individual case.
Scoliosis surgery: types and advanced techniques
Scoliosis surgery has advanced significantly over recent decades, with techniques tailored to the curve’s type, severity, and the patient’s age. Common procedures include spinal fusion to stabilize the spine and curvature correction using rods and screws. Additionally, newer approaches such as robot-assisted surgery and non-fusion fixation in pediatric cases have emerged. These innovations focus on enhancing correction outcomes, reducing complications, and accelerating recovery.
Spinal Fusion
Spinal fusion surgery is a widely used procedure for treating scoliosis, designed to correct spinal curvature by fusing two or more vertebrae for stabilization. This type of scoliosis surgery is typically recommended for severe curvatures exceeding 45 degrees or cases where the condition worsens or causes pain over time. It is particularly beneficial for neuromuscular scoliosis, which results from muscle or nerve disorders.
The procedure involves making an incision in the back to access the affected vertebrae, which are then stabilized using bone grafts or metal rods to realign the spine. Once the incision is closed, the recovery process begins. Scoliosis surgery offers several advantages, including correction of deformity, prevention of further curvature progression, improvement in posture and balance, and pain relief. Recovery duration varies based on the severity of the condition and surgical approach, with physical therapy playing a crucial role in regaining strength and flexibility. Some patients may require a back brace for a short period after surgery, and most experience significant long-term improvements in symptoms and spinal alignment.
Using metal rods and nails
Scoliosis surgery utilizes metal fixation devices such as rods and nails to correct and stabilize spinal curvature during spinal fusion. These rods are positioned along the spine and secured with precisely inserted nails, offering strong support to maintain spinal alignment. The primary function of these implants is to ensure spinal stability during the healing process, allowing the bone graft used in fusion to gradually integrate with the vertebrae, forming a single, properly aligned bone. The rods and nails play a crucial role in correcting curvature and maintaining the spine’s new position until complete bony healing occurs.
For children undergoing scoliosis surgery, special adjustable rods known as “growth rods” can be used to accommodate changes in height as they grow and develop. In some cases, shape-memory rods, which can be initially molded and then restored to their original shape with heat exposure, are employed to optimize curvature correction. Pedicle nails, inserted into the dense bony portion of the vertebrae, are a widely preferred choice due to their ability to provide stability and secure fixation during the procedure.
Non-fusion surgery (VBT – Vertebral Body Tethering) for children:
Vertebral Body Tethering (VBT) is a modern scoliosis surgery designed to treat idiopathic scoliosis in growing children, particularly when the curve continues to progress despite bracing. This technique was approved by the US Food and Drug Administration (FDA) in August 2019.
Scoliosis surgery using VBT follows the principle of growth modulation, gradually guiding spinal development toward a straighter alignment. The surgeon attaches metal stabilizers to the vertebrae on the convex side of the curve, securing them with an elastic cord placed under specific tension. As the child grows, this cord slows the growth on the curved side, allowing the opposite side to develop naturally, which leads to gradual spine straightening.
Which patients are candidates for scoliosis surgery?
The decision to undergo scoliosis surgery is determined individually, considering factors such as the severity of the spinal curvature, symptom progression, and the likelihood of deterioration. Surgery is typically recommended for severe or rapidly worsening curves, especially during active growth phases, to prevent further deformities or complications. Additionally, scoliosis surgery may be recommended when the condition significantly affects the patient’s quality of life or when conservative treatments, such as bracing or physical therapy, fail to halt progression or relieve symptoms.
The patient’s overall health also plays a crucial role in surgical planning, as they must be physically capable of tolerating the procedure and recovering effectively. Therefore, scoliosis surgery is only approved following a thorough assessment of the potential risks and benefits, ensuring the best approach for each case.
Recovery and rehabilitation after scoliosis surgery
Recovery after scoliosis surgery is a gradual process that typically spans six months to a year and requires strict adherence to a structured treatment plan for optimal healing. The patient progresses through distinct recovery phases, beginning with the initial postoperative stage. In the first weeks, hospitalization ensures necessary medical care, pain management, and early mobilization, including short-distance walking and light exercises. Proper wound care helps prevent infection, while emotional support from family plays a vital role in comfort and recovery.
Over the next three months, patients will gradually increase their physical activity under medical supervision, focusing on muscle strengthening and flexibility through tailored physical therapy. Strenuous activities that place excessive strain on the spine, such as jogging or weightlifting, should still be avoided. In the advanced recovery phase, which extends from the sixth month to the end of the first year, patients gradually reintegrate into their daily routines, including sports, while avoiding contact sports. Regular medical follow-ups remain essential for tracking progress and addressing potential complications.
Recovery timelines vary based on the specific scoliosis surgery performed and the patient’s overall health. Strict compliance with medical guidance, ongoing follow-ups, effective pain management, psychological support, and structured physical therapy are crucial for a smooth and successful recovery after scoliosis surgery.
Possible complications of scoliosis surgery
Scoliosis surgery is a complex procedure that carries several potential risks, all of which should be thoroughly understood before undergoing the operation. Below are the possible complications and the preventive measures taken to mitigate them.
- Bleeding: As with any spine surgery, scoliosis surgery poses a risk of unexpected bleeding. Surgeons control bleeding during the procedure by cauterizing blood vessels and replenishing lost blood as needed.
- Infection Prevention: Infection prevention is crucial during scoliosis surgery. Patients are advised to clean the surgical site with antiseptic soap before the procedure, and antibiotics are administered before and after surgery. Strict sterilization protocols are strictly followed in the operating room to minimize the risk of infection.
- Nerve injuries: Nerve damage can range from mild, such as temporary numbness due to nerve compression, to severe complications like paralysis. Although serious nerve injury is rare, it is not impossible. Surgeons monitor nerve function throughout the procedure using specialized electrical activity tracking to reduce this risk.
- Dural tear: During scoliosis surgery, the protective tissue that encloses the spinal fluid and nerves (the dura) may rupture, leading to leakage of spinal fluid. In mild cases, bed rest may be sufficient for recovery, while severe cases may require surgical repair.
- Failure of fusion (nonunion): Fusion is a gradual process that can take months or even years to complete. If fusion fails, it may cause persistent back pain, scoliosis progression, or implant failure, necessitating corrective surgery.
- Anesthesia complications: Since scoliosis surgery typically requires general anesthesia, some patients may experience allergic reactions or underlying medical complications. Anesthesia-related risks include respiratory infections, digestive issues like nausea and vomiting, and throat irritation due to breathing tube placement. In rare cases, vocal cord damage may occur.
- Deep vein thrombosis (DVT) prevention: Preventing DVT is vital, as blood clots in leg veins can lead to a life-threatening pulmonary embolism. To reduce this risk, doctors employ mechanical and pharmacological interventions, such as leg movement exercises, compression stockings to enhance circulation, and medications like heparin and Lovenox to slow blood clot formation.
Long-term results of scoliosis surgery
The long-term outcomes of scoliosis surgery are generally positive, with most patients experiencing significant improvements in spinal alignment, reduced pain, and enhanced quality of life. The primary objective of this procedure is to correct spinal curvature, leading to a more balanced and upright posture that positively impacts both appearance and self-confidence. Alongside aesthetic benefits, many patients find relief from chronic back pain associated with scoliosis, as surgery directly addresses the root cause, promoting long-term physical comfort.
Another key benefit is enhanced mobility, allowing individuals to perform daily activities more easily. Following scoliosis surgery, many individuals regain flexibility and resume activities they previously struggled with due to pain or movement restrictions caused by spinal curvature. Improved physical function also contributes to psychological well-being, with some patients reporting greater self-esteem and confidence, particularly as their body posture improves and feelings of disability or chronic pain diminish.
Despite the advantages of scoliosis surgery, patients should be mindful of potential long-term complications, including fusion failure, ongoing pain, or the possibility of additional procedures. Regular medical follow-ups are crucial for tracking post-surgical progress and ensuring the best possible outcomes, allowing any concerns to be addressed promptly and optimizing the benefits of the surgery.
Sources:
- American Academy of Orthopaedic Surgeons. (n.d.). Surgical treatment for scoliosis. OrthoInfo.
- National Health Service. (n.d.). Scoliosis. NHS.
