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Spinal Fusion Surgery for Scoliosis involves anchoring medical implants like hooks, screws, rods or wires to the curved bones of the spine and straitening it. This is followed by putting bone grafts over the spine. These grafts usually taken from the pelvic bone of the patient eventually grow and fuse together correcting the curvature of the spine.
Typical Conditions for Surgery
- Spinal curve is nearly 45 degrees at the time of skeletal maturity.
- A Scoliosis curve of nearly45 degrees at the time of skeletal maturity is most likely to persist curving with age. With advancement of adulthood, the spine could curve further by 1 or 2 degrees every year which could lead to acute deformity making treatment at that time much more difficult.
- Spinal curve is nearly 40 degrees even after bracing.
- If the curvature of the spine has reached 40 degrees even after bracing in a growing teenager, surgery would be advisable to ensure better results and decreased duration of time spent in a brace.
- The spinal curve hinders daily routine of activities
- There is severe back pain due to Scoliosis or difficulty in breathing
- X Ray and Blood Tests will be conducted
- Evaluation by anesthesiologist as this surgery is done under general anesthesia
Technique used for Surgery
Several techniques can be used to treat Scoliosis through spine surgery. These vary according to the age of the patient, location of the spinal curve, spinal maturity and severity of the spinal curve. The clinical observation of the surgeon and the preference of the patient and parent in case the patient is a child also influence the technique adopted for the surgery.
Techniques can also vary depending on what kind of medical implants are used and whether the surgery is done from the back called the posterior approach or is done from the front of the body called the anterior approach.
- Spinal Fusion for Scoliosis can be done in several ways, however most techniques involve use of screws and hooks. These are attached to the bones for anchoring long rods.
- After this the affected segments of the spine are repositioned with the help of rods. The segments are repositioned to align the spine correctly reducing the lateral twist.
- Bone grafts are then introduced into the segments where fusion is required. These bone grafts may belong to the patient (auto graft) or may be taken from a donor (allograft).
- The fusion of bones takes place within 3 to 6 months and continues for about 12 months. The rods hold up the spine till complete fusion has taken place and the new bones are able to take the load of the spine. However, rods are not removed afterwards since that would involve another surgery. Sometimes the rods may cause irritation of the soft tissues present around them and may require removal.
- Post operative recovery takes place several months
- However the hospital stay varies only between three to seven days
- Since it is a painful procedure, an epidural catheter may be inserted to control pain in the back of the patient. This is removed on the third day.
- The patient’s mobility is restricted and for this a catheter is connected to the urinary bladder which may also be removed on the third day after the surgery
- The patient is kept under the supervision of a physiotherapist who helps the patient to achieve the targets of mobility and movement.
- X-Rays are taken before discharge to check the condition of the spinal cord. If there is an indication of a complication, follow up procedures are taken to restore the well being of the patient.
Post Operative Care at Home
- It takes several months for the patient to resume movement and normal activity. Regular X-Rays and follow up examinations have to be done to make sure that the recovery is on track.
- The activities of the patient are limited. In the first six months, only simple daily routines are allowed.
- In the next two months, the patient can begin to swim.
- In 8-10 months after operation, the patient can resume exercise like bicycling.
- After 10-12 months, running, jumping and sports is allowed.
- After this, the patient’s progress is checked with an X-Ray and the patient can resume normal activities without any restrictions.
Risks of Scoliosis Spine Surgery
- Paraplegia or loss of movement in the lower parts of the body- Since this is a very calamitous complication, some tests like SSEP (Somato Sensory Evoked Potential) and MEP (Motor Evoked Potential) are used during surgery to keep a check and monitor if the spinal cord is compromised at any stage of surgery. If any of these tests indicate a complication, the surgery is reviewed immediately and further course of action is taken to restore the health of the spinal cord.
- Severe loss of blood- Since Scoliosis spinal surgery is a major operation, there is a lot of area exposed during surgery. The surgery also involves stripping of muscles. These complex factors can lead to severe blood loss. However with modern techniques, it is possible to keep the blood loss to reasonable levels. Patients can also be given their own blood that is donated prior to surgery and transferred later.
- Leaking of Cerebra Spinal fluid
- Failure of Instrumentation
- Failure of spinal fusion
Factors Affecting Cost of Scoliosis Spine Surgery
- Condition of the patient– If the patient’s condition is complex then the treatment becomes extensive, requiring additional resources
- Type of Material Used– The cost of the various metal implants used such as hooks, rods and screws varies and thus affects the cost of surgery
- The fee of the surgeon– Depending on the choice of the surgeon, the fee of the surgery may vary accordingly
- Hospital stay– Scoliosis Spinal Surgery is a major operation requiring 7 -8 days stay at the hospital which adds to the cost of surgery