Preparing for Surgery
The spine surgeon, including his staff will guide the patient through this process. For example, the patient will be required to obtain 'medical clearance' from their primary care physician or pediatrician. This is required by the hospital to admit the patient for surgery.
Most patients are permitted to exercise to 'tolerance'. Preoperative conditioning will help speed postoperative recovery. Patients who smoke must stop as smoking interferes with fusion and increases the risk of anesthesia.
The patient is asked to donate their own blood (autologous) or have family members donate on their behalf (donor-designated) in many cases. The question as to how many units should be donated can be answered by your surgeon. To some extent, the decision is up to the patient / family and amounts to how much insurance you want to have to minimize the need for transfusion of blood from the blood bank.
Surgical Risks
This topic is covered not to frighten, but to provide some information about the potential risks of surgery. Keep in mind, the majority of patients who undergo surgery do so without serious complications. Several potential problems are outlined below.
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Scoliosis Surgery: Rib Hump and Curve Correction
Thoracoplasty (Rib Resection)
Patients with scoliosis often have a prominent rib hump. One of the goals of corrective scoliosis surgery is to correct the rib hump. Thoracoplasty is a surgical procedure that helps to reduce rib hump size. The procedure involves partially removing as many as five ribs. This procedure is usually performed as part of the scoliosis surgery, but may be performed at a later time. Sometimes a chest tube drain is needed for a day or two after thoracoplasty is performed. Thoracoplasty is less commonly performed today than before because current advances in spinal instrumentation results in improved rotational correction of the deformity.
Osteotomies (Cutting and Removing Bone)
The term osteotomy means cutting into and removing bone. Osteotomies are performed in the front or back of the spine. In treating scoliosis curves, an osteotomy is used to improve correction of the spinal deformity. Osteotomies are used to treat adults with rigid scoliotic curves, children with large curves causing deformity, flatback correction, and in spinal reconstructions where realignment is needed after a prior spinal fusion.
For Full sotry go to Spine Universe
Patients with scoliosis often have a prominent rib hump. One of the goals of corrective scoliosis surgery is to correct the rib hump. Thoracoplasty is a surgical procedure that helps to reduce rib hump size. The procedure involves partially removing as many as five ribs. This procedure is usually performed as part of the scoliosis surgery, but may be performed at a later time. Sometimes a chest tube drain is needed for a day or two after thoracoplasty is performed. Thoracoplasty is less commonly performed today than before because current advances in spinal instrumentation results in improved rotational correction of the deformity.
Osteotomies (Cutting and Removing Bone)
The term osteotomy means cutting into and removing bone. Osteotomies are performed in the front or back of the spine. In treating scoliosis curves, an osteotomy is used to improve correction of the spinal deformity. Osteotomies are used to treat adults with rigid scoliotic curves, children with large curves causing deformity, flatback correction, and in spinal reconstructions where realignment is needed after a prior spinal fusion.
For Full sotry go to Spine Universe
Scoliosis Surgery: Approaches and Procedures
The scoliosis spine surgeon will choose the procedure that best treats the patient's problem. Sometimes more than one surgery produces the most favorable results. The surgeon will present the pros and cons of the different procedures so the patient and their family can make an informed decision with his guidance. Choices include:
- Posterior approach (back)
- Anterior-posterior approach (front and back)
- Anterior approach (front)
- Thoracoscopic surgery (VATS, Video-Assisted Thoracoscopic Surgery)
- Thoracoplasty (rib resection, rib removal)
- Osteotomies (bone removal)
- Hemivertebrae excision (partial or complete removal of a vertebra)
For Full story go to Spine Universe
Scoliosis: A Three-Dimensional Problem
The spine is a three-dimensional structure and scoliosis is a 3-D problem. Doctors refer to sections of the body as planes, or flat surfaces. Each plane has a name and these terms are used when discussing spinal alignment and balance. The terms are: sagittal plane (side view); coronal plane (front view); and, transverse or axial plane (top, bottom views). Scoliosis surgery addresses all three planes.
For Full story go to Spine Universe
For Full story go to Spine Universe
Scoliosis Surgery: Curve Considerations
Double "S" curves may require fusing both curves. Sometimes a selective fusion of only one curve can be done. Selective fusions require that one curve be relatively flexible; therefore, it does not need to be operated on.
If a selective fusion is performed, the second curve will be closely observed. If the second curve becomes larger, it may be treated by bracing (growing children) or may require surgery at a later time. The advantage of a selective fusion is that more motion segments are preserved than when more than one curve is fused.
Large, stiff (rigid) curves may require a combined front and back (anterior-posterior) surgery. Front and back surgeries are either performed on the same day or are staged to be performed as two separate procedures several days apart (sometimes longer). Occasionally, a rigid severe curve can be addressed all from a posterior approach with a procedure termed "vertebral column resection".
For Full story go to Spine Universe
If a selective fusion is performed, the second curve will be closely observed. If the second curve becomes larger, it may be treated by bracing (growing children) or may require surgery at a later time. The advantage of a selective fusion is that more motion segments are preserved than when more than one curve is fused.
Large, stiff (rigid) curves may require a combined front and back (anterior-posterior) surgery. Front and back surgeries are either performed on the same day or are staged to be performed as two separate procedures several days apart (sometimes longer). Occasionally, a rigid severe curve can be addressed all from a posterior approach with a procedure termed "vertebral column resection".
For Full story go to Spine Universe
Scoliosis Surgery: Goals and Considerations
Scoliosis surgery is complex and is a special surgical discipline within the area of spine surgery. One should choose a surgeon experienced in scoliosis surgical procedures. This includes the most current surgical techniques and treatment principles.
Why Surgery?
The reasons an adult undergoes scoliosis surgery may differ from a child. Most adults are treated for pain related to the scoliosis and deformity progression. Sometimes neurological deficits accompany adult scoliosis and require treatment. On the other hand, children are treated for progressive curves more than 40-degrees (for idiopathic scoliosis). Common to both adults and children is the goal of surgery: to avoid or stop pulmonary (lung) disease caused by severe thoracic (ribbed spine) curvature and to correct disfiguring spinal deformity.
Surgical Goals
Why Surgery?
The reasons an adult undergoes scoliosis surgery may differ from a child. Most adults are treated for pain related to the scoliosis and deformity progression. Sometimes neurological deficits accompany adult scoliosis and require treatment. On the other hand, children are treated for progressive curves more than 40-degrees (for idiopathic scoliosis). Common to both adults and children is the goal of surgery: to avoid or stop pulmonary (lung) disease caused by severe thoracic (ribbed spine) curvature and to correct disfiguring spinal deformity.
Surgical Goals
Although surgery to treat scoliosis is often complicated, the goals are simple:
- Stop and correct progressive spinal deformity
- Improve back and or leg pain
- Prevent or stop restrictive lung disease that is associated with severe thoracic curvature and more common in congenital scoliosis (lungs cannot expand fully making breathing difficult, the body may not get enough oxygen)
- Create a balanced and stable spine
- Create a solid fusion
- Save as many motion segments in the lumbar (lower) spine as possible to preserve motion (flexibility) and function
- Achieve a fine cosmetic result
For Full Story go to Spine Universe
Your Scoliosis Surgery: What You Should Know
Are you or your child facing scoliosis surgery? If so, you are not alone! Thousands of adults and children around the world undergo spine surgery to treat scoliosis each year.
Types of Scoliosis
Although there are many types and causes of scoliosis, about 80% are idiopathic. Idiopathic means the cause of scoliosis is not known. It is thought to be genetic or inherited in most cases. Other common causes include:
Types of Scoliosis
Although there are many types and causes of scoliosis, about 80% are idiopathic. Idiopathic means the cause of scoliosis is not known. It is thought to be genetic or inherited in most cases. Other common causes include:
- Congenital (such as caused by a hemivertebrae in which one side of a vertebral body fails to fully form creating a wedge-shaped body)
- Neuromuscular (associated with cerebral palsy, muscular dystrophy, polio, etcetera)
- Degenerative (disc 'wear and tear')
For Full Story go to Spine Universe
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