Scoliosis - Surgery

Patients are encouraged to donate their own blood before the operation for use in possible transfusions. The patient should have no sunburn, rashes, or sores on the back before the operation, which will increase the risk for infection.

Fusion

All scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary, however.

The Fusion Procedure. The fusion procedure generally is as follows:

The surgeon first slices flaps to expose the backs of the vertebrae that lie along the curve.
The surgeon then removes the processes, the bony outgrowths along the vertebrae that allow the spine to twist and bend.
The surgeon lays matchstick-sized bone grafts vertically across the exposed surface of each vertebra, being careful that they touch adjoining vertebrae.
The flaps are then folded back to their original position, covering the bone grafts.
These grafts will regenerate, grow into the bone, and fuse the vertebrae together.

Depending upon the severity and responsiveness to other treatment surgery may be recommended for the scoliosis. Surgical correction involves correcting the curve (although not all the way) and fusing the bones in the curve together. Bone grafts are laid across the exposed surface of each vertebra. These grafts will regenerate, grow into the bone, and fuse the vertebrae together. The bones are held in place with one or two metal rods held down with hooks and screws, which also helps to support the fusion of the vertebrae.

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Graft Materials. Bone grafts are taken from the patient's hip, ribs, spine, or other bones (called autografts). This is the best quality bone. However, because autografts are taken directly from the scoliosis patient, the operation is longer and the patient experiences more pain afterward. Researchers are also investigating allografts, which are bone grafts taken from another person or a cadaver. This would reduce the pain and duration of the operation. Allografts, however, pose an increased risk for infection from the donor. Longer-term studies are needed to determine the seriousness of this risk.

Investigators have been testing grafts made from ceramic material called tricalcium phosphate (Biosorb). In one comparative French study, these synthetic grafts were completely fused with the original bone in two years, while the natural bone graft was still evident on x-rays. In the study, the use of synthetic graft was associated with better spinal correction and a lower risk for viral infections.

Healing. The healed fusions harden in a straightened position to prevent further curvature, leaving the rest of the spine flexible. It takes about three months for the vertebrae to fuse substantially, although one to two years are required before fusion is complete. Fusion stops growth in the spine, but most growth occurs in the long bones of the body (such as in the legs), anyway. Patients, then, will most likely gain height from both growth in the legs and from the straighter spine. Patients make walk at slightly slower pace after fusion, but balance may improve, and sports activities are not restricted after the procedure.