Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
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.