Types of Surgery for Scoliosis: A Comprehensive Guide

Scoliosis is a challenging condition of the spine whereby the spine exhibits an abnormal lateral curvature. While most cases are treated conservatively with bracing or physical therapy, cases of severe scoliosis often need surgical correction. This article reviews the various types of surgical treatment for scoliosis to inform patients and caregivers about their options. 

When is Scoliosis Spine Surgery Necessary

In general, treatment of the scoliosis spine patient's curve is surgical if above 45 degrees to 50 degrees, curves worsen, cause pain or discomfort, show cardiopulmonary issues, or if interferes into the patient's daily living or quality of life. Various surgical options then are discussed.

1. Spinal Fusion Surgery

Spinal fusion was the commonest surgery for scoliosis. It will join permanently two or more vertebrae to stabilize the spine and stop further curvature progression.

The surgeon will then create an incision on the back, on the front (anterior) and sometimes through the side (lateral) of the spine. Metal rods and screws, and bone graft from either the patient or a donor, are then installed for correction and stabilization of the spine. Gradually the vertebrae fuse into a single solid bone, thereby preventing any further abnormal curvature. 

Advantages: Stops curve progression very well, relief of pain, improved posture, and long-term benefits. 

Risks and Considerations: Infection, nerve injury, or failure of union in a fused area are possible risks leading to additional recovery time.

2. Growing Rods Surgery

This procedure is for young children with progressive scoliosis. Since their spine is still growing, traditional spinal fusion is not feasible. Growing rods help guide spinal growth while controlling curvature. The surgeon implants adjustable rods along the spine. These rods are lengthened periodically (every 6-12 months) using minimally invasive techniques.

Benefits: They promote spine growth and posture straightening, delaying fusion until maturity. 

Risks and Considerations: Patients need several surgeries for rod adjustments, which risks breakage or infection, and can cause discomfort during the course.

3. Vertebral Body Tethering (VBT)

VBT is the newer and less intrusive available treatment than the spinal fusion. It is mostly advised for children and adolescents with moderate scoliosis who will need surgery. It involves implantation of a flexible cord (tether) with several screws placed along the vertebrae. 

The tether tightens up and will assume some spinal flexibility while correcting the curve. The child would grow straightened spine since it will allow the tether to straighten the spine, as he or she grows. 

Benefits: Maintains spinal mobility, shorter recovery than fusion and smaller incisions. 

Risks and Considerations: It cannot be used in all cases of scoliosis and may not prevent progression of the curve if tether breaks or fails.

4. Posterior Spinal Instrumentation and Fusion (PSIF)

This is a type of spinal fusion in which advanced instrumentation is then used to achieve a realignment and stabilization of the spine. Metal rods, hooks, screws, and bone grafts are used, thereby straightening and fusing the spine. The way to do this is through the back (posterior approach). 

Benefits: Strong spinal support and long-term stabilization, particularly for the severe cases of scoliosis. 

Risks and Considerations: Spinal fusion may pose risks, require a lengthy recovery, and lead to less flexibility.

5. Anterior Scoliosis Correction (ASC)

This minimally invasive surgical treatment that preserves spinal mobility but straightens the curves, making small incisions on the sides of the trunk. Screws along the vertebrae and a flexible cord are put in place to gradually reverse the curve.

Benefits: Less invasive than conventional fusion, preserves spinal movement, and results in shorter hospital stays and recovery periods. 

Risks and Considerations: Efficacy in severe scoliosis does not know; studies have been conducted about long-term effectiveness and risk of tether failure. 

Post-Surgery Recovery and Rehabilitation

After any type of spine surgery, most recoveries include: 

• 3 - 7 days of hospital stay.
• Brace that helps with further spinal support (might vary according to the surgery).
• Physical therapy to strengthen and regain flexibility. 
• Refrain from lifting heavy items for some weeks.
• Consequent regular follow-up to review progress.

Conclusion

The type of scoliosis surgery would depend on patient factors, including age, curve severity, and fitness. Spinal fusion remains the most used and trusted option, but emerging options such as VBT and ASC provide promises. Patients should consult with their spine specialists to know the most feasible treatment plan for their individual needs. 

Understanding these options provides the patients and caregivers with the knowledge to make informed decisions concerning scoliosis treatment which in turn makes for a better quality of life.