From the Guidelines
Surgical intervention for severe scoliosis is recommended when curves exceed 45-50 degrees or continue to progress despite conservative treatment, with the primary goal of halting curve progression, correcting deformity, and preventing future complications. The decision to operate is influenced by the severity of the curve, as well as the patient's overall health and potential for growth. According to the most recent guidelines 1, surgical decision-making is also influenced by the flexibility of the curves, which can be assessed using various radiographic techniques.
Surgical Options
The primary surgical options for severe scoliosis include:
- Posterior spinal fusion
- Anterior spinal fusion
- Combined anterior-posterior approaches These procedures involve the placement of metal rods, screws, and hooks along the spine to straighten it, followed by the fusion of the vertebrae together using bone graft material. For growing children, growing rod systems like MAGEC (magnetically controlled growing rods) or traditional growing rods may be used to allow continued growth while controlling the curve 1.
Special Considerations
In cases of early-onset severe scoliosis, VEPTR (Vertical Expandable Prosthetic Titanium Rib) devices might be employed. The timing of surgical intervention is crucial, as optimal results are achieved when lung function is satisfactory and before cardiomyopathy becomes severe enough to risk arrhythmia under anesthesia 2.
Recovery and Rehabilitation
Recovery from surgical intervention for severe scoliosis typically requires 3-6 months, with initial hospitalization of 5-7 days and activity restrictions for several weeks. Physical therapy is essential post-surgery to regain strength and mobility. The goal of these procedures is to improve the patient's quality of life by preventing future complications like pulmonary compromise or chronic pain that can occur with untreated severe scoliosis 1.
From the Research
Surgical Options for Severe Scoliosis
- Surgical interventions for severe scoliosis include posterior spinal fusion, anterior/posterior spinal fusion, and vertebral column resection 3, 4.
- The choice of surgical approach depends on the severity of the curve, the patient's age, and the presence of any underlying medical conditions 4, 5.
- Anterior/posterior spinal fusion is often used to treat severe and rigid scoliosis, and has been shown to result in significant improvements in curve correction and health-related quality of life 3, 6.
- Posterior spinal fusion is also a common approach, and has been shown to be effective in correcting curves and improving patient outcomes 7, 4.
- Vertebral column resection is a more invasive procedure that involves removing a portion of the spine to correct the curve, and is typically used for very severe cases of scoliosis 3.
Comparison of Surgical Approaches
- A study comparing anterior/posterior spinal fusion and posterior spinal fusion found that both approaches resulted in significant improvements in curve correction and health-related quality of life, but that anterior/posterior spinal fusion was associated with longer operation and hospitalization times, and more blood loss 3.
- Another study found that one-stage anterior-posterior spinal fusion was associated with shorter hospital length of stay and less crystalloid use compared to two-stage surgery 5.
- A decision analysis study found that anterior/posterior spinal fusion was the preferred surgical approach for treating scoliosis in skeletally immature females, due to the higher risk of curve progression with posterior spinal fusion alone 4.
Outcomes and Complications
- Surgical treatment of severe scoliosis has been shown to result in significant improvements in health-related quality of life, including reductions in pain and disability, and improvements in functional ability and cosmetic appearance 3, 6.
- However, surgical treatment is also associated with a risk of complications, including infection, nerve damage, and rod fracture 3, 6.
- A study of adults with severe scoliosis found that 64% of patients experienced at least one complication, and that 25% of patients required reoperation 6.