Scoliosis - Surgery

The Combined Anterior-Posterior Approach. The combination approach uses an anterior approach first, which allows better correction of the problems. The fusion part of the operation is done with the posterior approach. This is a very long and complex procedure. It appears to be safe, however, and is proving to be useful, even in very young patients, for preventing the crankshaft phenomenon. It may also be used to correct large rigid curves and for specific severe curves in the thoracic spine.

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Minimal Access Spinal Approach. Minimal access spinal technologies use a few small incisions and so are far less invasive than the standard so-called open approaches that require wide cuts. The technique uses endoscopy, in which the surgeon makes small incisions and inserts tubes that contain tiny instruments and cameras through the incisions in order to view and execute the procedure. In most cases, the procedure is done in two stages:

First, an anterior approach is employed to remove disk material and loosen the spine.
Secondly, a posterior approach is made for fusion and instrumentation.
Recovery after surgery is rapid. Most patients are out of bed two days after surgery.
Corrections are reaching 68% in some patients. There is a much more cosmetically appealing result (fewer and smaller scars) with endoscopy, and an easier recovery than with the more invasive approaches.

The endoscopic procedure for scoliosis is complicated and few surgeons can perform it yet. Currently, it is generally used only for single curves in the upper back or for patients with a curve in the upper back and a curve in the lower back that compensates for it. Some surgeons are now able to operate on areas below the diaphragm, including the lumbar spine. The patients must still wear a brace for three months afterward. Long-term studies are required to determine how outcomes compare to standard procedures.

Complications of All Procedures

Complication rates are high (nearly 10%) with any of these procedures, including the standard Harrington method and the newer Cotrel-Dubousset procedure. Complications for all procedures include allergic reactions to anesthesia and also include:

Bleeding. Standard procedures increase the risk for major blood loss during the procedure. Patients are encouraged to donate blood before the operation for use in possible transfusions. Children sometimes require more than one transfusion following surgery. Researchers are investigating various methods for reducing the need for transfusions: