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Scoliosis Surgery

While surgery may be necessary in some cases, in many cases it is not. Paul Harrington, known for inventing the surgery that implants metal rods in scoliotic spines, stated in 1963, "metal does not cure the disease" of scoliosis, which is a condition involving much more than the spinal column.

Lumbar Vertebrae
The vertebrae of the lower back below the level of the ribs.

Marfan Syndrome
A rare hereditary defect that affects the connective tissue.

Neurofibromatosis
A rare hereditary disease that involves the growth of lesions that may affect the spinal cord.

Osteoporosis
A bone disorder, usually seen in the elderly, in which the boned become increasingly less dense and more brittle.

Spinal Fusion
An operation in which the bones of the lower spine are permanently joined together using a bone graft obtained usually from the hip.

Thoracic Vertebrae
The vertebrae in the chest region to which the ribs attach.

Most spinal implants are made of metals such as titanium, titanium-alloy or stainless steel; some are made of non-metallic compounds. They come in many different shapes and sizes to accommodate different patients of all ages. Click to read about rod removal.

An operation on the spine is the only way to correct a scoliosis. It is a long and major operation and usually only considered for severe cases. However, the long-term results of the operation are usually good. See preparing for scoliosis surgery.

There are two main types of surgery:

  • Anterior fusion – this surgical approach is through an incision (cut) at the side of the chest wall; Posterior fusion – this surgical approach is also through an incision on the back and involves the use of metal instrumentation to correct the curve.
  • One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, will take four to eight hours. Your surgeon will discuss the full details of what will happen during with you.

Spinal fusion (An operation in which the bones of the lower spine are permanently joined together using a bone graft obtained usually from the hip) with spinal instrumentation is major surgery. The patient will undergo many tests to determine that nature and exact location of the back problem. These tests are likely to include x rays, magnetic resonance imaging (MRI), computed tomography scans (CT scans), and myleograms. In addition, the patient will undergo a battery of blood and urine tests, and possibly an electrocardiogram to provide the surgeon and anesthesiologist with information that will allow the operation to be performed safely. In Harrington rod instrumentation, the patient may be placed in traction or an upper body cast to stretch contracted muscles before surgery.

Scoliosis surgery is complex and should only be done by surgeons specialising in the subject who have appropriate training and infrastructure in their surgical units.

Spinal instrumentation is performed by a neuro and/or orthopedic surgical team with special experience in spinal operations. The surgery is done in a hospital under general anesthesia. It is done at the same time as spinal fusion.

The surgeon strips the muscles away from the area to be fused. The surface of the bone is peeled away. A piece of bone is removed - Autograft from the hip or ribs and could even be taken from someone else, (many hospitals have bone banks) and placed along side the area to be fused. The stripping of the bone helps the bone graft to fuse.

After the fusion site is prepared, the rods, hooks (used with rods and other implants to anchor them to vertebrae), and wires are inserted. There is some variation in how this is done based on the spinal instrumentation chosen. In general, Harrington rods are the simplest instrumentation to install, and Cotrel-Dubousset instrumentation is the most complex and risky. Once the rods are in place, the incision is closed.

Traditionally, the patient is awakened during surgery to ensure that the nerves are unharmed and movement is normal, or the surgeon may take a different approach with intraoperative spinal cord monitoring, where wire leads are connected from the patient's foot or leg to the skull. A neurotechnician constantly monitors nerve activity, which is detectable through these leads throughout the operation. The risk for nerve damage is low, at about 1 percent, and more commonly occurs in adult scoliosis surgery. In the months and years following surgery, there is the possibility of dislodged hooks; disc degeneration resulting in back and leg pain; and pseudoarthrosis, when a fusion doesn't heal properly and a false joint develops at that site.

There are around 30 such surgeons in the UK and the Republic of Ireland who are all members of the British Scoliosis Society. They are all very conscious of the need to consider the patient as a whole and safety is a top priority. Scoliosis surgery undertaken by these experts in units used to carrying out this work is no longer a great ordeal. Furthermore, modern methods for anaesthesia and pain control, and specialised nursing care, keeps to a minimum the pain and stress. Almost all patients and their families find surgery a positive experience with a satisfactory outcome and return to normality.

Since the hooks and rods of spinal instrumentation are anchored in the bones of the back, spinal instrumentation should not be performed on people with serious Osteoporosis. To overcome this limitation, techniques are being explored that help anchor instrumentation in fragile bones.

The one major worry at present is the very long waiting list for Scoliosis surgery on the NHS, which is generally many months. Sadly, this long wait is due to the absence of Government investment in spinal disorder services in general and Scoliosis units in particular. It is unacceptable to those who care for Scoliosis patients that curvatures in otherwise normal adolescents should increase significantly while they wait for hospital admission.