Each case of scoliosis-a three-dimensional curvature of the spine-is as unique as the person who has the condition. Sometimes the patient needs periodic observation by a physician, and in other cases, wearing an orthotic brace is beneficial. But when the curve measures more than 40-45 degrees, surgery may be the best treatment plan. However, patients should consult with their physician to determine the best treatment to fit their individual needs.

Surgical Approaches

 Scoliosis surgery begins with a single goal: taking a curved spine and making it straight, while preserving as much of the spine's natural mobility as possible. That may sound simple, but there are many complex variables to consider, such as the type of curve the patient has, the best way to access the spine, and what "tools" to use to best keep the supporting rods in place. 

These photos (courtesy of Dr. Sabharwal) clearly demonstrate the results of the corrective surgery.

Before		After

For many patients, an orthopedic surgeon or a neurosurgeon will perform a posterior spinal fusion with instrumentation. As the name suggests, the surgeon enters the body from the back. Bone is taken from another part of the patient's body and then grafted onto vertebrae. The bone graft literally acts as cement that may take months to "harden." To stabilize the fusion and hold the vertebrae in place during this time period, two stainless steel rods are attached to the spine with hooks and wires or pedicle screws.

Sometimes the surgeon determines that the best approach is from the front, or anterior region. In this type of surgery, the incision is made through the chest cavity. There are times when a combined anterior and posterior (from behind) approach is used.

Generally speaking, scoliosis surgery requires 4 to 5 hours in the operating room and a hospital stay of about 5 to 7 days. Most patients return to school or work 2 to 4 weeks after surgery; athletics can be resumed at about 6 months post-surgery.

In certain instances, surgeons may perform thoracoscopy-a type of minimally invasive surgery-to correct scoliosis. This technique results in smaller incisions ( five one-half inch incisions as compared with one 10-inch incision with traditional approaches), but it is reserved for cases that present with a very specific curve pattern.

Hooks or Screws, Which to Use?

During surgery to correct scoliosis, two stainless steel rods are placed alongside the spine. Traditionally, hooks are used around the spine to secure the rods; another option is the use of pedicle screws that enter into the bone. (Pedicles are the sides of the vertebrae.) Sometimes surgeons use a combination of hooks, screws, and wires. The choice of instruments is based on the patient's condition, the type of scoliosis, and the surgeon's training and experience. Patients considering surgery should consult with their surgeon to determine which approach is best for their individual needs.

One advantage of pedicle screws is that they enable the surgeon to attach rods to a shorter section of the backbone. This in turn provides the patient with more natural mobility.

Image-Guided Surgery

The clearer view a surgeon has of the area where he or she is working, the better. The surgeons who perform scoliosis operations may use a state-of-the-art, infrared-based Stealth(tm) surgical navigation system to gain the best possible perspective. With Stealth, computerized tomography (CT) scans of the spine are taken prior to surgery. During the operation, Stealth uses sensor-based optical tracking computer technology to accurately pinpoint areas of the spine on a "map" under real time; a special wand enables the surgeon to see below the bone while they operate as opposed to traditional methods which use images taken prior to surgery.

Intraoperative Spinal Cord Monitoring

One of the risks of scoliosis surgery is injury or damage to nerves contained within the spinal cord. Specifically, though unlikely, there is a chance of paralysis. Traditionally, the patient is awakened during surgery to ensure that the nerves are unharmed and movement is normal. University Hospital takes 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.

Bloodless Surgery and Scoliosis

Back surgery potentially involves significant blood loss. Some people, for religious or other personal reasons, choose not to receive blood transfusions. In conjunction with its University Center for Bloodless Surgery and Medicine, University Hospital is one of the few healthcare facilities in the nation to use state-of-the-art bloodless techniques. The surgeons at University Hospital who perform scoliosis are part of this Center and support a patient's desire to avoid blood transfusion.

Here's how bloodless surgery is possible. Certain types of medication and iron supplements can be given for a few weeks prior to surgery to stimulate the production of more red blood cells. During surgery, blood can be conserved by using meticulous technique and state-of-the-art surgical instruments to stop or prevent excessive bleeding. In many cases, blood lost during a surgical procedure can be salvaged and recycled.

For more information on bloodless techniques, visit the Center's web page at www.TheUniversityHospital.com/bloodless.

Risks of Scoliosis Surgery

In addition to the benefits surgery can offer, it also carries risks, including: blood loss; infection; complications associated with anesthesia; and damage to the spinal cord. 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.

Scoliosis Surgery at University Hospital

For surgeries as complex as those used to correct scoliosis, there's no substitute for an experienced health care team. At University Hospital in Newark, this experience is evident at every level of care, from surgeons who specialize in spinal surgery to the nurses in the Pediatric Intensive Care Unit to the physical therapists who provide post-surgical therapy. Specifically, University Hospital offers scoliosis patients: