In this article I’m going to talk about who would be referred to surgery and what the common surgical procedures are.

Standard Care Model

If you are young and not finished growing and your curve is between 10 and 25 degrees there might not be any need to do anything drastic.  The standard recommended action is to just observe your back with x-rays every 6 months.

However I would disagree with this approach and say yes to the observation  but also add in the exercises in the scoliosis correction protocol.

If you are still growing but your curve is between 25 and 45 degrees you will be recommended bracing, but remember, braces cannot reduce a curve, they can only stop it from progressing, so in order to reduce the curve you would need to add in the scoliosis correction protocol.

If you have finished growing and your curve is between 25 and 45 degrees then observation and the exercises like the Scoliosis Correction Protocol™ are for you.

The medical world uses 50 degrees as a mark to offer surgery.  This may change from country to country or doctor to doctor but it is generally the accepted severity of curve that would need surgery.

Finally, if you are still growing and  your curve is  greater than 50 degrees there is a concern that the curve will continue to progress, so you will be most likely be offered surgery before it gets to 80.  You may also be offered surgery even if you have finished growing and your curve is stable, because in some people a curves between 50-100 degrees can cause some stress to your heart and lungs (that would be determined by further testing).

With smaller curves, if the appearance of the curvature is bothersome or if symptoms are associated with the scoliosis are affecting your quality of life you may also be offered surgery. The goals of surgical treatment is to obtain a straighter back in the frontal plane, de rotate the scoliosis in the transverse plane and ultimately prevent it from coming back.

Surgery

The most common surgery for  straighter spine is generally achieved by placing implants onto the spine that are then attached to rods.  The rods run up either side of the spine and act like a mast, keeping everything straight.  They also put little bits of bone, called bone grafts, in the joints between individual vertebrae to stop them from moving. The rods then hold the spine still until they fuse which means the bones of the spine grow together.

The surgery has many stages but the main ones are:

• Placing the implants – the things that hold the rods into place.
• Straightening the spine
• Bone grafts
• Placing the rods.

You should look one up on YouTube, but be warned they are really graphic.

There are many different ways this can be done so if you are offered surgery the surgeon may name the type of surgery they want to do.

Different Surgical Approaches

OK, so surgery isn’t something you should just jump into.  There are lots of different procedures used for different situations, you need to know which one is best for you.

• Anterior approach (just going in via the front)
• Thoracoscopic surgery (VATS, Video-Assisted Thoracoscopic Surgery)
• Thoracoplasty (rib resection, rib removal)
• Osteotomies (bone removal)
• Hemivertebrae excision (partial or complete removal of a vertebra)
• Vertebral column resection – removal of a vertebra
• Vertebral tethering
• Vertebral body stapling —Staples are used through thoracoscope and inserted into the spine. The staple acts as a clamp to stabilize the spine. Depending on the severity of the curve, a rod may be used to stabilize the spine while it heals.
• Vertebral wedge osteotomy —A wedge-shaped portion of the bone in the spine is cut out on one side of the curve. The open space left in the spine is then closed together. A temporary rod is inserted while the bones heal.
• Magnetically controlled growing rods —A rod is implanted to straighten the spine. Growth adjustments to the rod are done with a magnet, minimizing invasive surgical procedures.
  
  Questions to Ask Your Surgeon

• What are the risks of surgery? (both short term, and long term) – You want to know what could go wrong and what are the chances of it going wrong.  You don’t want to wake up to find out that a misplaced screw has caused nerve damage in your spine and not even know that it was a possibility.
• What testing is needed before surgery? (Blood work, urinary analysis, lung function)
• If you are paying for it how much does spinal fusion surgery cost?
• How many spinal surgeries has my surgeon performed and has he or she had good results? (If the surgeon is new, will there be a consultant on hand to help if necessary)
• If surgery is for your child, should you and your child consult a neurosurgeon? (This may be important as the spine will need to grow even though it has rods in.
• How long will surgery last?
• Will I be in a lot of pain? What can help me cope with pain?
• Should I or someone else donate blood? Will I need a transfusion?
• How long will I be in the hospital? What kind of physical limitations will I have?
• Do I need to wear a brace after surgery? (that would be a bit of a shock if you didn’t know that you needed to have surgery and wear a brace!)
• Will I need physical therapy?
• How soon after surgery can I shower or wash my hair? (This may sound like a small thing but can become a big deal, the more you know the better)
• When can I go back to school or work?
• When can I be active again (i.e., play sports)?
• How will surgery limit my flexibility (e.g., bending over, ability to walk, range of motion?)
• Where will with the extra bone for the fusion come from, what site harvested? (Common places are the top of the pelvis, a bone called the iliac crest, you’ll want to know what happens there, as the place where the bone is taken from can get infected and be painful)
• Will I need more than one surgery?
• Who can I speak with or what can I read to better prepare for surgery?

You need to be totally informed of all the risks and limitations that go with the surgery before you commit. So, if you are in a situation where you have been recommended for surgery or if your spine is still growing and the rate of the curve is rapid and you think surgery might be in your future, I urge you to do your homework, and understand exactly what you are committing  to.

Ed Paget is an exercise physiologist and osteopath. He specializes in helping people recover from spinal problems, including scoliosis, with none invasive exercise based protocols.

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