The human spine has certain normal curves. These curves give our lower back a slight arch and position the body’s weight over the hips and pelvis, allowing us to stand and move in balance. Some individuals, however, lose their normal spinal alignment due to abnormal curvature of the spine. This is not a function of poor posture, and these curves can’t be fixed by merely standing up straight; scoliosis surgery may be necessary. The condition of side-to-side spinal curvature is called scoliosis. On an x-ray, these spines with scoliosis look more like an “S” or a “C” than a straight line. The overall balance of the body can also be affected with the head or trunk shifted either to the side or forward in front of the hips. There are specific types of scoliosis that can affect people at different stages of life.
Children and adolescents may develop curves that may be termed congenital, juvenile, or adolescent scoliosis. The most common form of pediatric scoliosis is Adolescent Idiopathic Scoliosis (AIS). Research is beginning to clarify a genetic basis for AIS, but “Idiopathic” is a general medical term that means “of undetermined cause”.
Adult scoliosis may arise from undiagnosed or untreated childhood scoliosis that has progressively worsened. Commonly, adult scoliosis is caused by degenerative conditions such as disc disease and arthritis that leads to progressive deformity of the spine.
Not every patient with scoliosis requires surgery. For example, brace treatment may be recommended in younger patients who are not yet skeletally mature (still growing). Regardless of the patient’s age, scoliosis can become progressive, leading to increasing pain, deformity, and even problems with the heart and lungs (severe scoliosis).
Many scoliosis patients will not need surgery. Dr. Stieber carefully considers the results of the patient’s physical examination, x-rays, and advanced imaging studies such as CT or MRI scans.
About Scoliosis Surgery
The primary purpose of scoliosis surgery is to stop the curve from progressing (getting worse) and stabilize the spine. The secondary goal of surgery is to correct the deformity. Scoliosis surgery is performed using general anesthesia. The skin area(s) is cleaned and prepared for surgery. A special computer monitoring system checks the spinal cord and nerve function throughout the procedure to prevent injury. Throughout the surgery, fluoroscopy, or a type of spinal navigation system, enables Dr. Stieber to view the patient’s anatomy and the surgery in real time.
Surgery may be performed from the front (anterior), back (posterior), or side – between the ribs (thoracoscopic) and may involve removing one or more discs (discectomy) or cutting bone (osteotomy). For certain types of adult scoliosis, Dr. Stieber is able to utilize cutting-edge minimally invasive techniques to correct the deformity and achieve improved spinal alignment.
Bone graft is inserted into the empty space between the upper and lower vertebral bodies and around the instrumentation. Spinal instrumentation, such as rods and screws, are implanted to fix the spine in position. The body’s natural healing processes cause new bone to grow into and around the instrumentation resulting in spinal fusion.
Types of Bone Graft
- Autograft is the patient’s own bone. Autograft may be bone taken from the patient’s neck during laminectomy or in a separate procedure where the bone is taken from the patient’s hip.
- Allograft is donor bone from a bone bank.
- Bone graft substitutes; there are different types, some of which are synthetic (man-made) and available in different shapes.
Post-operative x-rays are performed to ensure curve correction and that the rods, screws, and grafts are well-positioned. The wound is closed and bandaged. Scoliosis surgery usually takes several hours. Dr. Stieber discusses the type of surgery and its anticipated duration with the patient well before the surgery date.
After surgery, the patient is moved into the recovery area. In recovery, nurses and other members of the medical team closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative pain should be expected, and patients receive pain medication either through their IV (intravenous line) or by mouth.