Surgical Treatment for Scoliosis
Common Questions About Surgery for Scoliosis
Most scoliosis surgeons agree that children who have very severe curves
(50 degrees and higher) will need surgery to lessen the curve and
prevent it from getting worse.
The operation for scoliosis is a spinal fusion. This is essentially a
"welding" process. The basic idea is to realign and fuse together the
curved vertebrae so that they heal into a single, solid bone.
With the tools and technology available today, scoliosis surgeons are able to improve curves significantly.
Do I need surgery?
If your curve is greater than 50 degrees, it will most likely get
worse, even after you are fully grown. This may increase the cosmetic
deformity in your back, as well as affect your lung function. Surgery is
recommended.
Curves between 40 and 50 degrees in a growing child fall into a grey
area — several factors may influence whether surgery is recommended.
These should be discussed with your surgeon.
How successful is surgery for scoliosis?
Spinal fusion is very successful in stopping the curve from growing.
Today, doctors are also able to straighten the curve significantly,
which improves the patient's appearance.
How straight will my spine be after surgery?
Because your spinal bones protect your spinal cord, your surgeon will move the bones only as far as is safe.
The degree of correction from surgery depends on how flexible your
scoliosis is before your operation. In general, the more flexible your
curve is, the better the correction from surgery. Your doctor can
measure your flexibility before surgery with special x-rays called
bending or traction films.
Most patients recover from surgery with curves less than 25 degrees. In many cases, these small curves are hardly noticeable.
I have back pain associated with my scoliosis. Will the surgery relieve it?
Immediately after surgery, there will be more pain than before, but
this usually resolves over a period of a few weeks to a few months. Most
patients report that their back pain is better at 1 year from surgery
than it was beforehand.
The x-ray on the left shows two large curves that require surgery.
The x-ray of the same patient on the right after surgery to correct
the curves.
Courtesy of Texas Scottish Rite Hospital for Children.
Everyone — whether there is scoliosis or not — has some back
discomfort from time to time. Expecting to never have any future back
pain would be unrealistic.
What is involved with a spinal fusion surgery?
In a spinal fusion, the curved vertebrae are fused together so that
they heal into a single, solid bone. This will stop growth completely in
the abnormal segment of the spine and prevent the curve from getting
worse.
All spinal fusions use some type of bone material, called a bone
graft, to help promote the fusion. Generally, small pieces of bone are
placed into the spaces between the vertebrae to be fused. The bone grows
together - similar to when a broken bone heals.
Metal rods are typically used to hold the spine in place until fusion
happens. The rods are attached to the spine by screws, hooks, and/or
wires.
Exactly how much of the spine is fused depends upon your curve(s).
Bone is scooped out of the iliac crest to be used as a bone graft.
What is a bone graft?
A bone graft is primarily used to stimulate bone healing. It increases
bone production and helps the vertebrae heal together into a solid
bone.
In the past, a bone graft harvested from the patient's hip was the
only option for fusing the vertebrae. This type of graft is called an
autograft. Harvesting a bone graft requires an additional incision
during the operation. It increases the length of surgery and can cause
increased pain after the operation.
One alternative to harvesting a bone graft is an allograft, which is
cadaver bone. An allograft is typically acquired through a bone bank.
Today, several artificial bone graft materials have also been developed.
How long does the surgery take?
Most fusions last from 4 to 12 hours, depending on the size of the
patient's curve and how much of the spine needs to be fused.
How much pain will I be in after surgery?
The amount of pain people report after surgery varies a great deal
from patient to patient. The surgery is a major procedure that involves
moving muscles and realigning the skeleton.
The first few days are usually quite uncomfortable, but most people
improve rapidly by the third or fourth day, and they can walk around,
and get in and out of bed well enough to go home. The pain continues to
improve gradually and most teenagers can return to school by 2 to 3
weeks after surgery.
Mild pain may persist, but by 3 to 6 weeks after surgery, pain medicine should no longer be necessary.
What type of pain control will there be after the operation?
Pain control varies between different doctors and hospitals. In many
cases, a PCA (patient controlled anesthesia machine) is used, which
injects a small dose of pain medicine intravenously when you push a
button. Some surgeons use an intravenous catheter (small plastic tube
placed in a vein) to provide the medication. The pain relief system that
your doctor is accustomed to using is probably the safest and most
reliable for you after surgery.
On the second or third day after surgery, your doctor will most
likely change your medication to pills or liquid pain relievers taken by
mouth. These medicines are an opiate (morphine-like medicine.) Because
these medications are known to be addictive if taken for a long time,
you will be encouraged to switch to acetaminaphen as soon as possible
after you go home.
Do the hooks and rods stay in my spine even after it has fused?
If rods are used in a fusion, they usually do not need to be removed.
However, a few people may require rod removal for a variety of reasons.
Will fusion make my back stiff and unable to move?
After spinal fusion most people have enough motion in their backs to
perform all activities of daily living and most sports. If you
participate in activities that require a tremendous amount of
flexibility, it may take awhile to adapt. Most people find that within a
year or so their backs begin to feel "normal" when participating in
those activities.
Can I have my scoliosis corrected without a fusion?
We wish that we had a method and materials that would straighten the
spine and also allow normal motion between all the bones. Unfortunately,
we do not have this capability. Anything we put in to hold the spine
straight, also makes the spine stiff in the area of surgery.
Scoliosis surgery can be done without performing a fusion.
Unfortunately, the rods that straighten the spine will eventually break
if the bones between them do not grow together. So if fusionless surgery
is done, it will probably need to be redone over and over again.
Common Questions About Surgical Recovery
Most patients are in the hospital for 4 to10 days, out of school for 2 to 6 weeks, and back into activities in 2 to 6 months.
How long do patients need pain medication after being discharged home?
Most surgeons prescribe strong pain medicines to patients after
scoliosis surgery. Patients who have not used opiate pain killers before
usually stop needing them within 2 to 4 weeks after surgery. If the
patient has used these medicines frequently before surgery, it may take
longer to stop needing them.
It is best to stop taking these strong medicines as soon as possible
because they can be addictive if taken for long periods of time.
Does surgery lead to permanent restrictions on activities?
No, most patients are able to return to all their favorite activities and sports.
Most patients return to non-contact sporting activities (running,
weightlifting, exercises) approximately 4 to 6 months after surgery.
Before returning to all activities, including contact sports, the
spine must be fully healed. It typically takes 6 to 12 months after
surgery to obtain a solid fusion of the spine and get back to all
activities.
Will I be able to walk after surgery?
Yes. Some patients may need physical therapy after surgery, but they
are able to walk when they are discharged from the hospital.
When can I go back to school after the operation?
Most children miss between 2 to 4 weeks of school after surgery. It
typically takes about 4 weeks before the spine is healed enough for
carrying a backpack.
When can I start hanging out with my friends again?
Your friends can visit you after surgery in the hospital and at home.
Going out with your friends — like to school functions or the movies —
can occur after you are off all pain medications and are feeling back to
normal (this usually happens about 4 weeks after surgery).
Scoliosis Surgery: Things to Consider
Many things need to be considered when planning surgery for scoliosis.
This article provides answers to common questions about cost, risks and
complications, as well as concerns teenagers have about how they will
look after surgery.
Common Questions When Considering Scoliosis Surgery
When should surgery be scheduled?
Most scoliosis surgeons agree that there is rarely a need for
emergency or urgent surgery. Most surgeries can be scheduled for a time
that works for both the patient and the doctor. If you decide to
postpone your surgery until a school break, your doctor will follow up
with you every few months to make sure there is not a rapid increase in
the size of the curve once it is greater than 50 degrees.
Should I have allograft bone used for my fusion or my own bone harvested?
At this time, your own bone is still an excellent option, but many
scoliosis surgeons now use allograft bone instead. The reason for this
is that some patients end up having pain at the donor site (from where
the bone was taken) and this can last a long time. Other problems such
as bleeding, nerve irritation, infection, or fracture can happen on rare
occasions.
Bone is scooped out of the iliac crest to be used as a bone graft
Allograft bone is taken from a deceased donor. It goes through an
extensive sterilizing (cleaning) process before it is used on a patient.
Allograft bone is often mixed with the patient's own marrow blood to
improve its bone fusion capability.
In addition, spine surgeons are also using synthetic (artificial or
man-made) products to get the spine to fuse. These products can be used
with your own bone or with an allograft (donor bone). They act as a
scaffold (framework) to allow new bone to form and mature. Some of the
synthetic materials available can actually stimulate new bone to form in
the operated area. They go by the name BMP (stands for bone
morphogenetic protein) and your surgeon may bring it up while discussing
your surgery. It has been used extensively in the spine and other bony
areas in the body for the past several years.
The exact type of bone graft used will depend on many factors, the
most important of which is surgeon preference and experience. That is to
say, if your surgeon has had very good success with one method or
approach, he or she will probably recommend it to you. Of course you and
your family should ask about other options available to you and then
decide which method you would prefer.
How much does spinal fusion surgery cost?
The cost of surgery for scoliosis and other types of spinal curvatures
depends on many factors. They include the cost of being in the hospital
for several days, types of materials used (hooks, screws, rods), bone
graft material, surgeon's fees, and anesthesia charges. Unexpected
events that result in an extended hospital stay will also increase the
overall cost.
The actual costs vary from region to region in the United States, and from country to country.
In the United States, costs also vary depending on the type of
insurance coverage you have. Many insurance companies cover the cost of
the surgery, the hospital stay, and the instruments to straighten the
spine. You may owe a co-payment or you may be billed the balance of what
your insurance does not cover.
Be sure to contact your insurance provider prior to surgery to
discuss the extent of your coverage. Talk with your doctor's office, as
well as the hospital billing department to make sure you understand all
the costs involved.
Although the exact costs vary from patient to patient, in general, spinal surgery for scoliosis is an expensive operation.
How many spinal surgeries has my surgeon performed and has he or she had good results?
Talk with your surgeon. Because not all spinal surgeons treat
scoliosis patients, it is important to ask your surgeon if treating
scoliosis is an important part of his or her practice. There are many
regional spine centers and teaching institutions that specialize in
treating teenagers with scoliosis and other curvatures of the spine.
Should my child see a neurosurgeon?
The vast majority of surgeries for scoliosis and other curvatures of
the spine have been performed by orthopaedic spine surgeons. Over the
last several years, however, some neurosurgeons have taken a special
interest in treating teenagers with scoliosis and have gone through
specialized training.
Certain types of curvatures are associated with problems related to
the spinal cord. If your child has other symptoms with the curve, like
pain, weakness, or numbness, it may mean that the nerves from the spine
are being compressed by the bones or the disks. This is rare, but should
be watched out for. A neurosurgeon may be requested to be a part of the
surgical team.
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