What is Scoliosis Correction ?

Surgery for Scoliosis correction is indicated for one or more reasons llike progressive curve, severe curve, or curves of spine resulting in mechanical symptoms like unrelenting backache, or neurological symptoms from nerve compression like leg pain , weakness , progressive neural deficit or paraplegia .The decision process for surgery depends on a number of factors: the type of imbalance, a history of prior surgeries, the degree and location of neural compression, the age and health of the patient, among other things.

There are two types of surgeries in scoliosis correction – Growth friendly which allow growth to occur along with gradual deformity correction over time, and other is One time fusion surgery with spinal instrumentation and implants which involves fusion (stops growth) surgery with instruments along with one time correction

Growth Friendly Surgery
In the past, spinal fusions were the usual treatment for early onset scoliosis. It is now understood that early fusion of the thoracic spine will limit the growth of the lungs as well as the spine and can lead to severe respiratory problems. Growth friendly surgical procedures, that correct the deformity while avoiding long fusions of the spine, are being developed and refined. Today there are a number of possibilities, each with their own benefits and disadvantages.

Growth Friendly Surgery :

In the past, spinal fusions were the usual treatment for early onset scoliosis. It is now understood that early fusion of the thoracic spine will limit the growth of the lungs as well as the spine and can lead to severe respiratory problems. Growth friendly surgical procedures, that correct the deformity while avoiding long fusions of the spine, are being developed and refined. Today there are a number of possibilities, each with their own benefits and disadvantages.

In general, the type of surgery may be divided classified as
(1) Distraction-Based, (2) Guided Growth, and (3) Compression Based.

Fusion with Instrumentation Surgery :

In some cases, fusion with instrumentation n surgery will be advised.. This may be indicated when the child is closed to the end of growth or when co-existing medical problems make the growth friendly procedures, which often require multiple surgeries, too dangerous. In most cases this will involve posterior spinal instrumentation and fusion of the entire deformity. When a significant amount of growth remains, a posterior fusion may result in a twisting or “crankshaft” deformity as the growth of the anterior or non-fused front of the spine is tethered by the fused posterior portion. To avoid this problem an anterior fusion is often performed at the time of the posterior procedure in selected children. These procedures are covered elsewhere.

Surgery involves one of the various steps of scoliosis surgery

1. Spinal Instrumentation Spinal instrumentation involves insertion of pedicle screws in the desired vertebrae and connecting them by a rod posteriorly in the desired position.

2. Correction manoeuvres intraoperatively under the safety limits of the surgery.

Spinal Deformity correction by Correction manoeuvres like
1. Rod rotation
2. Translation
3. Cantilever Bending
4. Direct vertebral Rotation DVR
5. In situ Bending
6. Distraction / Compression

3.Spinal osteotomies (removal of a part of bone/vertebra) to correct the deformity and spinal instrumentation for achieving a spinal fusion in desired position. There are various options like Pontes Osteotomy , Pedicle subtraction Osteotomy , Vertebral Column Resection

4. Discectomy , Thoracoscopic release , Hemiepiphysiodesis In Situ Spinal Fusion ,Hemivertebra Resection are few other surgical techniques used for scoliosis correction

5. Bone Grafting – Auto grafting Vs allografting options are available with there own described advantages and disadvantages .

There are a number of techniques described in scoliosis correction 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.

Posterior Surgery :

(from the back) involves the removal of some of the joints of the spine and cor-rection of the deformity using screws, hooks and rods and supplemented with bone graft.

• Occasionally, a combination of an anterior and posterior surgery may be necessary which may be done on the same day or separate days.