by Carson-DeWitt R

Surgical Procedures for Scoliosis

Surgery is usually reserved for severe cases of scoliosis with a degree of curvature over 40°-50°.
The goals of surgery are to:
  • Stop the progression of scoliosis
  • Lessen the curve
  • Avoidance of complications in adulthood, such as lung disease due to restriction of a deformed chest cavity
Many types of techniques can be used for scoliosis. These techniques have some or all of the following in common:
  • Efforts to restore some symmetry to the torso and pelvic areas.
  • Supporting the vertebrae.
    • This can be done with or without hardware, such as steel rods, screws, or hooks.
    • Procedures can be done with or without spinal fusion.

Fusion Surgery

Spinal fusion surgery involves joining together adjacent vertebrae to result in growth into one solid bone. This results in permanent restrictions on certain types of movement. The restriction depends on how many bones are fused together. Hardware is used to keep the spine in place while the bones fuse together.
Cortel-Dubousset Procedure
This is one of the most common surgeries performed for scoliosis. This type of surgery is a posterior spinal fusion. A metal rod is attached to each side of the spine by using hooks attached to the vertebral bodies. The spine is then fused with a piece of bone from the hip area. The bone grows in between the vertebrae and holds them together and straight. The metal rods attached to the spine help the backbone remain straight while the spinal fusion takes place.
Thoracoscopic Anterior Instrumentation
Small incisions are made for insertion of a thoracoscope and surgical instruments. Thoracoscopic surgery is less invasive, but in some studies surgery and recovery times appear to be longer than conventional surgery. Although there are some benefits to this type of surgery, serious post-surgical complications are possible. If this surgical procedure is an option for your child, be sure to weigh out all the options with the doctor.

Non-Fusion Surgery

Non-fusion surgical procedures are designed to help the curve correct itself over time. These procedures do not restrict movement once the spine has healed. Some of these are somewhat new procedures, and may not be available everywhere.
  • Epiphysiodesis—This procedure is designed to stop growth on one side of the spine. The other side of the spine will continue to grow. There will be slow, progressive correction.
  • Vertebral body stapling—Staples are used through thoracoscope and insterted into the spine. The staple acts as a clamp to stabilize the spine. Depending on the severity of the curve, a rod may be used to stabilize the spine while it heals.
  • Vertebral wedge osteotomy—A wedge-shaped portion of the bone in the spine is cut out on one side of the curve. The open space left in the spine is then closed together. A temporary rod is inserted while the bones heal.
  • Magnetically controlled growing rods—A rod is implanted to straighten the spine. Growth adjustments to the rod are done with a magnet, minimizing invasive surgical procedures.

References

Altaf F, Gibson A, et al. Adolescent idiopathic scoliosis. BMJ. 2013;346:f2508..

Idiopathic scoliosis in children and adolescents. American Academy of Orthopedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Updated March 2010. Accessed November 22, 2013.

Kim KT, Park KJ, et al. Osteotomy of the spine to correct spinal deformity. Asian Spine J. 2009;3(2):113-123.

Maruyama T, Takeshita K. Surgical treatments of scoliosis: A review of techniques currently applied. Scoliosis. 2008;3:6.

Reddi V, Clarke DV Jr, et al. Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis: a systematic review. 2008;33(18):1986-1994.

Scoliosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 29, 2013. Accessed November 22, 2013.

Trobisch P, Suess O, et al. Idiopathic scoliosis. Dtsch Arztebl Int. 2010 Dec;107(49):875-883.

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