Surgical treatment of scoliosis
From Prof. Dr. Murat Bezer

Surgical treatment of scoliosis

Skolyoz FilmiWhat is the purpose in surgical treatment of scoliosis?

The purpose in surgical treatment of scoliosis is to align the vertebrae and fuse them together (spinal fusion surgery). This region acts like one bone (vertebra) after fusion.

Who needs surgical treatment in scoliosis?

Curvatures above 45-50 degrees generally continue to progress even after puberty. The progression may disrupt pulmonary function as well as it may produce an ugly appearance in the back. Most of the doctors who do scoliosis surgery suggest surgical treatment in such a case in order to correct the scoliosis curvature or to stop it from progressing.

Patients who have 40-50 degrees Cobb angle can be suggested different treatments sometimes. What is the reason of this?

For children patients who have 40-50 degrees of scoliosis, the decision of surgery should be made after evaluating many different factors. It is best to decide for the surgery after discussing it with an experienced orthopedic surgeon.

How successful is scoliosis surgery?

Modern technology has improved the surgeons’ ability to correct scoliosis curves. Achieving an aesthetic appearance is possible. Spinal fusion surgery in which the curved vertebrae are fused together is quite successful.

How much correction can be achieved by scoliosis surgery?

The vertebrae protect the spinal cord. So the surgeons try to achieve the maximum safe correction possible during the surgery without harming the spinal cord.

Is it possible to foresee how much correction the patient could achieve before the surgery?

Some special tests can be done before surgery like traction x-ray in order to see how flexible the scoliosis curve is. The surgeon can have an idea about the flexibility by the help of these x-rays. The more flexible the curve is the more correction we can achieve.

Where and what size of incision is needed for scoliosis surgery?

Scoliosis surgery is generally done by a straight incision in the middle of the back. The length of the incision is 2-3 centimeters more than the length of the vertebrae that are to be corrected.

Does scoliosis surgery leave scars in the skin?

The skin is stitched using aesthetic sutures after scoliosis surgery in order to prevent scars. Other precautions include using anti keloid gels and covering the incision under the sun for one year after the surgery.

Does the rib hump disappear after scoliosis surgery?

The rib hump is corrected by a surgical technique called derotation. But another surgery called thoracoplasty which involves a partial removal of the ribs may be needed for patients who have a severe rib hump since derotation could deform the ribs. Thoracoplasty may be performed at the same time with scoliosis surgery or as a second surgery at another time.

Does back pain decrease after scoliosis surgery?

Back pain generally increases during the first days after surgery. But it starts to decrease after a few weeks/months. Patients often state after 1 year that they don’t have as much pain as they had before surgery any more.

How does spinal fusion surgery affect scoliosis?

Spinal fusion surgery stops the abnormal region of the spine from growing and thereby prevents the progression of scoliosis.

How are the vertebrae fused together?

The vertebrae are fused together by means of bone grafting. The facet joints are fused with each other just like the fusion of bone fractures.

Does spinal fusion decrease back motion?

The fused vertebrae become motionless for life. Therefore it is important to correct the scoliosis by fusing the least number of vertebrae possible. Most patients have movable vertebrae enough to move around, sit and stand up after the surgery. The untouched vertebrae regain enough motion and flexibility to do almost all kinds of sports within a year.

Is it possible to cure scoliosis without spinal fusion?

The ultimate dream of orthopedic surgeons is to find a cure that corrects the scoliosis and protects normal vertebral motion. But all surgical treatments today decreases vertebral motion somehow by correcting scoliosis.

What are the implanted metal screws and rods for?

Metal screws and rods are used for transferring the power and maneuver necessary to hold the vertebral column in a certain position in order to correct the scoliosis. The screws are implanted in the two pedicles of the vertebrae. The rods are installed in the spaces in these screws. These metal parts are mostly produced from titanium or stainless steel.

Do these metal parts stay in the body for good?

The screws and rods used in scoliosis surgery do not have to be removed again unless in rare cases like infections or fractures in the rods.

How many vertebrae should be fused? How is it decided?

This varies depending on the scoliosis patient but fusing the least number of vertebrae positively affects the range of motion after surgery. Therefore scoliosis surgeons take special x-rays for planning the surgery and they try to use full maneuver during the operation in order to fuse the least number of vertebrae possible.

Why is bone grafting used?

Bone grafts are used to promote vertebral fusion. There are three types of bone grafts.

Autograft: The bone is often taken from the pelvis of the patient in scoliosis surgeries. It is not used as much as before nowadays due to the facts that it requires another incision in the body, extends the duration of the surgery and creates another painful region in the patient’s body.

Allograft: The bones are obtained from cadavers and prepared by bone banks. Their usage is more extensive today due to the higher reliability in terms of sterilization.

The third alternative is bone grafts that are produced artificially or from corals.

How long is a scoliosis surgery?

A scoliosis surgery takes 4-8 hours depending on the length of scoliosis curvature and the number of vertebrae that are to be fused.

Is there a lot of post-operative pain?

The severity of pain depends on the patient’s threshold of pain. There are patients who say that they don’t feel any pain after the surgery as well as those who say that they feel severe pain. Scoliosis surgery is a big operation in which the vertebral column is repositioned and the muscles are relocated. Generally, the patients have more pain for a few days after the surgery but it starts to decrease from the third day on and they get discharged from the hospital. The pain then continues to decrease and school-age children can go to their schools within 2-4 weeks. Some patients may have to use light painkillers for 6 weeks at maximum.

Which painkillers can be used after surgery?

Your doctor decides the type of painkillers you use. They usually choose patient-controlled analgesia (PCA). In PCA, the patient can receive a low dose of analgesic by pressing a button when he/she feels pain. Some doctors may choose to infuse the analgesic consistently. These analgesics are often drugs like morphine that are called opioids. They are not used for a long time. These methods give place to painkiller tablets and syrups after the second day.

Is there a limit for visitation in the hospital after scoliosis surgery?

First-degree relatives can visit the patient in his/her room after the first day. The patient’s room should not be crowded. The friends’ visits should start after first medical dressing and the patient is on his/her feet.

When does the patient start walking after scoliosis surgery?

The patients can start walking in the second day after surgery.

How long go patients stay in the hospital after surgery? When can they return to school?

Although there are differences in patients and scoliosis surgery techniques, the patients are generally discharged from hospital in fifth day at the latest. They return to school within 3-4 weeks. Carrying backpacks is allowed after one month.

Which activities should be avoided after surgery?

Patients are generally required to avoid bending too much and lifting heavy objects for 3 months.

Are there any restrictions on sports after surgery?

Patients can start light sports such as swimming, jogging and cycling after the second month. Most of the patients have no obstacle on doing the same sports they do before surgery. Heavy sports (like body-building) and contact sports (like football) is generally allowed after the sixth month. This six-month restriction is based on the fact that a full spinal fusion does not occur before six months.

When can the patient drive or go to theaters and movies after surgery?

The patients can start going out to movies and theaters after they do not need or rarely need painkillers (generally 3-4 weeks). As a rule, they are not allowed to drive unless they stop taking painkillers. Patients usually start driving within 1.5-2 months after scoliosis surgery.