Scoliosis and Kyphosis Surgery
Spinal deformity
Scoliosis
A loss of the normal spinal alignment is referred to as a spinal deformity. Scoliosis (abnormal sideward bending of the spine) and kyphosis (abnormal forward bending of the spine) are the two common types of deformity. Some of these deformities can progress and need treatment.
Spinal deformities could result from a variety of causes and in a majority of adolescents, the exact cause is unknown (idiopathic). Other causes for a spinal deformity are vertebral anomalies that occur by birth or as a manifestation of some other disease (eg neurofibromatosis, polio, cerebral palsy and Marfans syndrome). In adults, spinal deformity can be due to degenerative conditions, previous spinal surgery or even childhood deformities that have persisted.
Treatment options for scoliosis and kyphosis
- Observation - Serial radiographs (xrays) to assess progression
- Brace - Usually recommended during the growing stages in children and adolescents
- Surgery - Surgery is indicated when curve progressive occurs or is anticipated, or to correct a cosmetic deformity that is unacceptable to the patient. In adults, pain relief and improving function may be additional considerations
Scoliosis
Scoliosis
Congenital scoliosis
Surgical options for the correction of spinal deformities
Degenerative scoliosis
There are a number of alternatives in spine deformity surgery
- Anterior surgery (from the front through the chest wall or abdomen) involves the removal of intervertebral discs and correction of the deformity using screws and rods and/or bone graft (taken from the pelvis)
- Posterior surgery (from the back) involves the removal of some of the joints of the spine and correction of the deformity using screws, hooks and rods and supplemented with bone graft (taken from the pelvis)
- Occasionally, a combination of an anterior and posterior surgery may be necessary which may be done on the same day or separate days
After surgery
- In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. You will be given pain medications, antibiotics, intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. When you are comfortable you will be transferred to your room.
- In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. Medications will be provided to reduce your pain after surgery and at home for the first 3-4 weeks. However, if you have excessive pain while you are in the hospital, the attending nurses should be informed. The day after surgery, the drain tube and the urinary catheter will be removed. You will stay in the hospital for 5-10 days and your surgeon will decide when you can go home.
- At home: Once you are at home, it is important to stay active and take short walks at regular intervals to help reduce pain and hasten your recovery. Gradually increase the distance you walk each day but avoid strenuous activities, heavy lifting and twisting. You may require some help with chores and errands for the first few weeks and it is advisable to have someone to help with these activities. Children and teenagers can return to school/college after six weeks and contact sports are not advisable for the first six months.
Kyphosis
Risks and potential complications
Kyphosis
All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. Allergic reaction to the anaesthetic or other medications and unforeseen complications such as pneumonia, stroke or heart attack are not caused by the surgical treatment and although rare it may have serious consequences. Please let your surgeon and anaesthetist know if you are allergic to medications and if you have any medical problems (relating to your heart, lungs, diabetes or increased blood pressure) and provide a list of your current and past medications.
The surgical complications include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, or injury to the nerve tissue or its surrounding protective layer. Injury to the nerves may occur during surgery, resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.
Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.
After surgery for kyphosis
Venous thrombosis (DVT - clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs, although we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.
The insertion of the screws can potentially cause nerve injury, resulting in weakness and abnormal sensations in the legs. Great care is taken to ensure the accurate placement of the screws, including the use of intra-operative fluoroscopy (x-rays). Correction of the deformity can also cause stretching of the nerves and spinal cord and may result in nerve injuries.
Another potential risk is that the fusion may not become solid, resulting in non-union, or pseudarthrosis. This may occasionally require a repeat surgery after a few months to supplement the bone graft to obtain a solid bony fusion.
Anterior scoliosis
surgery - Front view
Anterior scoliosis
surgery - Side view
Posterior scoliosis
surgery - Front view
Posterior scoliosis
surgery - Side view
Notify your surgeon at once if you notice the following after surgery
- Excessive bleeding
- Redness or discharge from the wound
- Fever
- Persistent headache
- Weakness or numbness in the arms and legs
- Difficulty in passing urine
Talk to your surgeon
This is a brief overview and does not contain all the known facts about your condition and the treatment options. Feel free to seek any clarifications from your surgeon and his team. It is important for you to obtain a clear understanding of your condition and the risks, benefits and limitations of the surgical procedure before proceeding.
