Idiopathic Scoliosis

Adult

Surgical Treatment

Surgical treatment is reserved for a small subset of patients who have failed all reasonable conservative (non-operative) measures. They generally have disabling back and/or leg pain and spinal imbalance. Their functional activities are severely restricted and their overall quality of life has reduced substantially.

The goals of surgery are to restore spinal balance and reduce pain and discomfort by relieving pressure off the nerves (decompression) and maintaining corrected alignment by fusing and stabilizing the spinal segments. In some instances, minimally invasive decompressions may be all that is necessary. Surgical stabilization involves anchoring hooks, wires or screws to the spinal segments and using metal rods to link the anchors together (Figure 1). They act as a tether and allow the spine to fuse in the corrected position. Fusion is performed by using the patient’s own bone or using cadaver or synthetic bone substitutes. In more severe cases, spinal segments have to be cut and realigned (osteotomy) or entire segments may have to be removed prior to realigning the spine (vertebral column resection) (Figure 2). There are many different types of surgical procedures designed to treat adult spinal deformities. Surgeons need to customize the surgery for each patient depending on their needs. When larger surgeries are necessary (greater than 8 hours), surgery may be divided into two surgeries 5-7 days apart.

It is important to note that surgery in adults is riskier than in the adolescent. The complication rate is significantly higher and the recovery is a lot slower. Therefore, surgery should only be undertaken as a last resort and only after the patient has a clear understanding of the risks and benefits. All reasonable non-surgical measures should be attempted first. At the same time, when patients are carefully chosen and are mentally well-prepared for the surgery, excellent functional outcomes can be obtained which at times can be a positive life changing experience for a given individual patient.

Recent advances in surgical techniques include less invasive approaches by making smaller incisions as well as using biologic substances to accelerate the fusion process. Use of computer-assisted navigation systems and various forms of spinal cord and nerve monitoring may help in improving surgical precision and accuracy.

A and B) Front and Side X-rays of a patient with post-laminectomy scoliosis. C and D) Postoperative front and side X-rays showing a fusion from the upper thoracic spine to the sacrum.

Figure 1: A&B) Front and Side X-rays of a patient with post-laminectomy scoliosis. C&D) Postoperative front and side X-rays showing a fusion from the upper thoracic spine to the sacrum.

A) The pink and blue areas represent the areas of bone resection in a vertebral column resection. B) After the vertebra is removed from the back of the spine, a supportive cage is placed between the segments. C and D) Front and side X-rays of a woman with fixed, rigid scoliosis. E and F) Postoperative front and side X-rays show her improved alignment.

Figure 2: A) The pink and blue areas represent the areas of bone resection in a vertebral column resection. B) After the vertebra is removed from the back of the spine, a supportive cage is placed between the segments. C&D) Front and side X-rays of a woman with fixed, rigid scoliosis. E&F) Postoperative front and side X-rays show her improved alignment.

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