There are many nonsurgical treatment options available for mild scoliosis and kyphosis. However, more serious cases may require surgery to treat the condition. Surgery can stabilize the spine through fusion of the bone tissue. This is known as spinal fusion.
Surgery for scoliosis and spinal deformity corrects abnormal curves in the spine and limits future curvature. Scoliosis and kyphosis symptoms are often greatly improved after surgery, along with overall quality of life.
Seton Healthcare Family offers a range of surgical options for spinal fusion. Whenever possible, our specialists take a minimally-invasive surgical approach to treating spinal deformity.
Minimally Invasive Surgery for Scoliosis and Spinal Deformity
In an XLIF procedure, the surgeon approaches the spine through a lateral position. To begin, the patient lies on their side. An X-ray is taken to show the exact portion of the spine to be operated on. Small incisions are made on the side of the body. This approach avoids the major back muscles.
A nerve-monitoring probe helps guide the surgeon and protect nearby nerves. An instrument known as a retractor is used to gently move tissue so the surgeon can see the spine. Through the incisions, the surgeon is able to access the spine and prepare the space for fusion. This includes removing some disk material.
An implant with grafted bone is inserted. Spinal implants stabilize and hold bones in place until new bone tissue fuses with the vertebrae to form one solid bone mass.
Additional X-rays may be taken to confirm correct alignment. Plates, screws or rods are fixed to the implant for further stabilization.
The XLIF procedure is not appropriate for all cases of scoliosis. It cannot treat the lowest level of the spine.
This minimally invasive surgery uses specialized equipment to perform a spinal fusion. To begin, several small incisions are made on the patient’s side. Through one of these incisions, a thin telescope-like instrument with a tiny video camera is inserted. This instrument is called an endoscope.
The endoscope sends internal images to a monitor in the operating room. The endoscopy, combined with continuous X-ray imaging, gives the surgeon the ability to perform the spinal fusion surgery with great precision.
Disc material is removed from curved part of the spine. This removal provides room for spinal fusion. Screws are fixed to the vertebrae in need of correction. Bone graft is then added to the space between the vertebrae to promote fusion.
A customized rod is attached to the screws at each vertebra. The screws are tightened to minimize curvature and achieve better alignment.
Not everyone with scoliosis is a candidate for this surgery. This procedure is most effective when fusion is needed in the thoracic spine of the middle and upper back.
Far Lateral/XLIF and MIS Instrumentation offer several advantages over more traditional surgeries:
- Less scarring
- Less muscle damage
- Smaller chance of nearby tissue complications
- Less blood loss and discomfort
- Shorter hospital stays
- Faster recovery and return to activities
Other Surgical Procedures for Scoliosis and Spinal Deformity
Pedicle Subtraction Osteotomy (PSO)
PSO is recommended for people who need a moderate degree of correction, mostly in the lower back. It involves removal of a section of a bony tube going from the front and back of the vertebra. This tube is called a pedicle. A wedge is taken from the bone and the whole vertebra is bent backwards. This can restore between 20 and 40 degrees of curvature.
Flatback Syndrome Correction
The spine has two places where it curves to help balance the weight of the body. Flatback syndrome describes a spine that is straight rather than curving where it needs to. In some cases, the syndrome may result from a previous scoliosis treatment.
Surgery may be required to address flatback syndrome if nonsurgical treatment options have not worked. The goals of flatback syndrome correction are to:
- Improve spine position
- Relieve stress on back, hips and knees
- Provide pain relief
- Prevent further problems
An osteotomy may be performed to correct flatback syndrome. This involves making cuts into a bone, usually in a wedge shape. Bone implants or structural devices may be added to restore curvature. Rods and screws hold the correct alignment while bone fusion occurs.
The type of osteotomy will depend upon degree of correction that is needed and the location of the problem area.
Vertebroplasty and Kyphoplasty
Vertebral compression fractures (VCF) can result from osteoporosis, spinal injury or spinal tumors. can weaken the vertebrae and result in a ‘collapsing’ spine. When left untreated, the spine will continue to weaken and collapse into itself, contributing to scoliosis or kyphosis.
In a vertebroplasty procedure, the doctor injects bone cement into the fracture of the bone using a hollow needle. This can allow the spine to straighten, reducing pain and preventing further collapse.
Kyphoplasty may also be used to treat a collapsing spine. It is a minimally invasive, image-guided procedure. A balloon device is inserted directly into the fracture. A specialized X-ray guides the placement. A paste-like cement is then added to re-establish the original height of the collapsed vertebra. This helps to relieve pain, straighten the spine and prevent further damage.
The back part of the vertebra that covers the spinal canal is the lamina. Laminectomy, also known as decompression surgery, removes the lamina to make more room in the spinal canal. The procedure is most commonly performed in the low back and the neck. Widening the canal relieves pressure on the spinal cord or nerves that may be caused by a herniated disc or stenosis.
Revision surgery to correct spinal alignment may be necessary for a number of reasons. Scoliosis surgery stabilizes and corrects only the affected areas of the spine. After surgery and over time, the spine may develop more curvature. Flatback syndrome can also develop years after scoliosis surgery. Previous spinal surgery may not have adequately aligned the spine or a hardware failure may require surgical removal.
Experience the Seton Difference
Our centers are located in Austin and throughout Central Texas. To learn more about spine care from the Seton Healthcare Family, please visit one of our locations.