There are two main ways to respond to scoliosis: surgical treatment versus nonsurgical treatment. There are also different types of scoliosis surgery, and it’s important that patients understand the pros and cons of surgical treatment, along with how different types of surgery can affect the spine.
Traditional scoliosis surgery is a type of spinal fusion, and this is performed with the goal of stopping scoliosis from progressing but, fusing the spine is contrary to its movement-based design, and the type of surgery performed is important.
As the goal of scoliosis surgery is to stop progression, let’s take a minute to explore the condition’s progressive nature.
Scoliosis is a Progressive Condition
Scoliosis is incurable and progressive, but it can be highly treatable.
Scoliosis being progressive means it has it in its nature to get worse over time, and that means the size of the unnatural spinal curve is going to increase, as will the condition’s effects.
Scoliosis gets more complex to treat as it progresses not just because the scoliotic spinal curve is getting larger, but also because progression makes the spine more rigid and less responsive to treatment; it can also make it difficult for some patients to perform certain therapeutic exercises as part of treatment.
As scoliosis progresses, the condition’s uneven forces are increasing, and symptoms of scoliosis are going to become more noticeable.
In children, the main condition effect is postural deviation, and this commonly includes uneven shoulders, shoulder blades, the development of a rib cage arch, uneven hips, and arms and legs that appear to hang at different lengths.
In addition to the visual changes, scoliosis can also cause disruptions to balance, coordination, and gait.
In addition to the condition’s progressive nature, it’s also important to understand that scoliosis ranges widely in severity and there are also different types of scoliosis a person can develop; these are two important factors when it comes to crafting a treatment approach and deciding whether scoliosis surgery is the best option or not.
Scoliosis Severity and Condition Type
Scoliosis severity is a key piece of information that’s needed to diagnose, classify, and treat scoliosis.
Severity is determined by a measurement known as Cobb angle, and this is determined during X-ray by drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae, and the resulting angle is expressed in degrees.
The higher the Cobb angle, the more unnaturally tilted the curve’s vertebrae are, the more complex it will be to treat, and the more out of alignment the spine is:
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
When it comes to traditional scoliosis treatment, when/if a patient progresses into the severe classification and shows signs of continued progression, they become a surgical candidate.
As mentioned, there are also different types of scoliosis, and these different types have unique characteristics and treatment needs.
The main type to affect all ages is idiopathic scoliosis, meaning not clearly associated with a single-known cause, and the most prevalent type of scoliosis overall is adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18.
Approximately 80 percent of known cases are idiopathic, and the remaining 20 percent have known causes: neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.
As the condition’s progression is triggered by growth, scoliosis patients who are still growing are at risk for fast progression, and adolescents with their rapid and unpredictable growth spurts of puberty are the most at risk for rapid-phase progression.
Now that we’ve explored some basic characteristics of scoliosis and scoliosis treatment, let’s talk specifically about the different types of spinal surgery for scoliosis.
What is Spinal Fusion Surgery?
Spinal fusion surgery is performed with the goal of stopping progression, and it does this by fusing the curve’s most-tilted vertebrae at its apex into one solid bone, and commonly, this involves the removal of intervertebral discs sitting between adjacent vertebrae to be fused.
An intervertebral disc is replaced by a bone graft that heals over time and helps stabilize the spine.
Next, rods are commonly attached to either side of the spine with pedicle screws to hold it in place.
This surgical procedure is lengthy, costly, and invasive, and there are also different types of scoliosis surgery to consider.
Posterior spinal fusion refers to typical spinal fusion as described above, but the term anterior spinal fusion has a different approach.
Anterior Spinal Fusion Surgery
In typical posterior spinal fusion, the surgeon performs the procedure and accesses the spine through the back, but anterior spinal fusion accesses the spine from the abdomen, and this is done to spare cutting of muscles in the back.
In anterior spinal fusion, an incision is made in the abdomen and blood vessels and organs are carefully pushed to the side to avoid being cut, and this makes recovery faster.
Anterior spinal fusion is less invasive and lengthy as it can be performed as an open surgery.
An additional benefit of an anterior approach is that a larger disc cage can be used to provide more stability and increase the space left between vertebral bodies (less spinal rigidity and better range of motion).
This approach also doesn’t require the use of rods and/or screws and can be performed as a stand-alone fusion.
Video-Assisted Thoracoscopic Scoliosis Surgery (VATS)
Video-assisted thoracoscopic scoliosis surgery is minimally invasive and involves surgeons accessing the spine from the front (anterior side), and this is beneficial for certain types of scoliosis affecting the thoracic spine.
The procedure uses a thoracoscope, a tiny video scope, that’s inserted through a small incision so tissue can be spared and surgical cuts can be precisely guided.
Thoracoscopes stream live video so surgeons can direct their instruments with the least amount of damage; most often, the camera is inserted into the chest cavity through small incisions made in the chest wall.
This procedure is less invasive than traditional spinal fusion, which means a shorter recovery period, less muscle and tissue damage; healing from muscle damage can be lengthy.
Osteotomies
Spinal osteotomies are surgical procedures used to treat a number of structural spinal conditions.
An osteotomy is a type of restructuring procedure that involves the removal of entire vertebral bodies or sections of vertebrae, and this is done to facilitate proper spinal alignment to fix conditions like scoliosis that cause the spine to become misaligned.
There are different types of spinal osteotomies, one of which is a vertebral column resection which is the most invasive type of osteotomy and involves the removal or one or more vertebral bodies and their discs in between; this is used to treat severe spinal conditions that cause the spine to become increasingly unstable.
Vertebral Body Tethering
Vertebral body tethering (VBT) is a type of scoliosis surgery that involves growth modulation so is ideal for young patients who have not yet reached skeletal maturity.
The procedure is an alternative to traditional spinal fusion that involves making small incisions down the side, known as portals, through which anchors are attached to the spine; tethers are then attached to the anchors, and tension can be adjusted on the tether to pull the spine into an aligned position.
The advantage to this is the port of entry isn’t the back so muscles, ligaments, and vessels can be pushed aside, rather than cut to access the spine, and this makes the recovery process significantly shorter, and as tension on the spine can be adjusted, it allows for the spine’s natural growth and can be adjusted accordingly.
Vertebral body tethering can also help preserve more of the spine’s natural flexibility and range of motion than traditional spinal fusion surgery.
Conclusion
While there are different types of scoliosis surgery for scoliosis patients to choose between, all spinal surgery comes with its share or potential risks, side effects, and complications so should be considered carefully; the truth is that many cases of scoliosis don’t require surgical intervention, particularly with early detection.
Diagnosing scoliosis early in its progressive line doesn’t guarantee treatment success (nothing can do that), but it is associated with better results as the curve is mild, as are the condition’s effects, and it’s far more effective to proactively work towards preventing progression than it is to attempt to reverse its effects once established.
When it comes to scoliosis surgery, the goal is to stop progression, but this isn’t the same as correcting scoliosis on a structural level, and this is the goal of modern conservative nonsurgical scoliosis treatment.
Here at the Scoliosis Reduction Center®, patients benefit from a surgical treatment alternative that preserves as much of the spine’s natural strength and function as possible.
A spine that’s fused is not going to be as strong or flexible, and many patients commit to scoliosis surgery because they think it will return their bodies to a pre-scoliosis state, but this isn’t the case; scoliosis surgery focus on the spine and the spine alone so many postural changes, particularly in the hips, remain after surgical procedures.
When a person is diagnosed with scoliosis, the most important decision to be made is whether to treat it with surgical or nonsurgical treatment, and for those on the path of traditional scoliosis treatment, there is the further choice of the type of scoliosis surgery to commit to.
