A Patient’s Guide to Scoliosis Surgery
If you have severe scoliosis (>50 degrees), then your doctor may suggest surgery to fix your condition. This is especially true if you are an adult who has reached spinal maturity. As we age, degenerative changes in our spine become more common. Unfortunately, this also means that your scoliosis will only continue to worsen.
If your child has severe scoliosis, then your doctor will likely try nonsurgical treatment options first. These methods often include scoliosis bracing to prevent the curve from progressing; physical therapy to strengthen the back muscles; and chiropractic care to realign the spine.However, none of these methods can reverse the damage that has already been done. And, sometimes scoliosis is so severe, that your doctor must perform surgery ASAP. For example, in children with severe scoliosis, Thoracic Insufficiency Syndrome (or TIS) may arise. TIS occurs when the lungs cannot develop properly because the spine is compressing the chest. In a case such as this, your child will need surgery to restore lung function and promote healthy lung development.
Likewise, your doctor may recommend surgery if your curve is <50 degrees, but if you have been living with chronic pain for longer than 6 months. To find out if you qualify for scoliosis surgery, contact Dr. Jason Lowenstein, MD. A scoliosis and spinal deformity expert, Dr. Lowenstein offers a wide range of minimally invasive treatments for scoliosis pain.
The 4 Basic Types of Scoliosis Surgery
If your scoliosis requires surgery, then you will have many different procedures from which to choose. However, scoliosis surgeries tend to fall into 4 basic categories. These include:
Spinal Fusions for Scoliosis
Most forms of scoliosis surgery use spinal fusion to realign and restabilize the spine. Even if spinal fusion is not the primary purpose of the procedure. For example, during an osteotomy, your surgeon will remove entire vertebrae or segments of bone to help restructure the angle of the spine. Although bone removal is the name of the game here, your doctor must also use spinal fusion to reinforce the spine as it heals.
However, you shouldn’t consider spinal fusions to be an afterthought. Often, they are the main event. Spinal fusions involve using hardware to reshape the curvature of the spine. Once your doctor has installed rods and screws to reroute your spinal curve, he or she will insert a bone graft into the space between the target vertebrae. As the bone graft matures, the two vertebrae will fuse into one strip of solid bone. This leaves the patient with a spine that is both straighter and sturdier.
If you need spinal fusion to adjust your curvature, then your doctor will likely use 1 of 3 approaches. These procedures are aptly named according to the direction from which your surgeon will access your spine. These include:
- Anterior Lumbar Interbody Fusion (ALIF): This technique involves accessing the spine from the anterior (or front) side. In particular, an ALIF allows your surgeon to spare the muscles of your back from incision.
- Posterior Lumbar Interbody Fusion (PLIF): This approach requires your surgeon to enter the spine from the back (or posterior) side. Because a PLIF forces your surgeon to cut through the muscles in your back, this surgery requires a slightly longer recovery time.
- Combined Approach: However, most spinal fusions for scoliosis will require your surgeon to approach the spine from both the front and back side. In the long-term, a front and back approach offers the patient greater spinal stability.
Adjustable Growing Rods for Scoliosis
If your child is younger than 10-years-old, then your doctor may recommend the use of growing rods to moderate scoliosis progression. Growing rods allow your child’s spine to grow until enough skeletal maturity has been achieved to undergo spinal fusion.
Like spinal fusion, your doctor will attach rods, screws, and hooks to the spine and/or ribs. However, unlike spinal fusion, as your child’s spine matures, your doctor can lengthen these rods. Your doctor can achieve this lengthening process by several different means. These may include:
- General Anesthesia: Traditional growing rods require the child to undergo additional surgeries in order to extend the rods. For example, if your child receives the VEPTR (vertical expandable prosthetic titanium rib device) to correct Thoracic Insufficiency Syndrome, then he or she will need to undergo adjustment surgery every 6-8 months.
- Magnetically Controlled Growing Rods (MCGR): Some children with scoliosis will qualify for MCGR instead of tradition systems. MCGR allows your child’s surgeon to adjust the rods using magnets in lieu of surgery.
Fusionless Systems for Scoliosis
An up and coming technique, Vertebral Body Tethering (VBT) is a growth modulation system for scoliosis. VBT makes use of the Hueter-Volkmann Law. This principle states that forces which compress bone tend to slow bone growth. (And, in contrast, forces that pull on bone–known as tensile forces–tend to encourage bone production.)
Therefore, during VBT, your surgeon will implant screws on the outside of the scoliotic curve. These screws are attached to a flexible cord, which when pulled, applies a compressive force. However, your surgeon will not modify the inside (or concave) part of the curve with hardware. Because your surgeon places one side of the curve under compression, it grows more slowly than the concave side.
As the spine matures, VBT uses natural laws of bone growth to right spinal curvature.Osteotomies for Scoliosis
Your surgeon will reserve osteotomies for the most severe cases of scoliosis. During an osteotomy, your surgeon will remove entire vertebrae or segments of vertebrae to create a hinge on the back side of your spine. After your surgeon creates this hinge, he or she will close the gap by folding the spine into a more natural position. In the last phase of this surgery, your doctor will use spinal fusion to ensure that your spine heals safely and with sufficient support.
From least to most invasive, these techniques include:
- Posterior Column Osteotomy (PCO): During a PCO, your surgeon will remove your spinous process (the “points” on the back side of each vertebrae), your lamina, and facet joints.
- Pedicle Subtraction Osteotomy (PSO): During a PSO, your surgeon will remove the same structures as before, however the pedicles will also be removed. Your pedicles connect your vertebral body to your spinous processes.
- Vertebral Body Resection (VBR): This takes the PSO one step further and involves removing an entire vertebra or vertebrae to restructure the spine.
Are you looking for scoliosis solutions? To find the best options for you, contact our spinal deformity experts at The Advanced Spine Center in Morristown, NJ. Our fellowship-trained spine surgeons treat scoliosis using both surgical and non-surgical methods, scoliosis bracing, and more! To receive the highest standard in scoliosis treatment for you or your child, contact The Advanced Spine Center today!