Spinal Fusion for the Treatment of Idiopathic Scoliosis in Children: Orthopedic Surgery to Treat Curvature of the Back in Children and Teenagers
Edited By: Kit M. Song, M.D.
Last updated Thursday, October 20, 2005
Considering surgeryWhat kinds of surgery are recommended for idiopathic scoliosis? There are several different types of surgical options for
idiopathic scoliosis.
The most common is to perform a spinal fusion where a
surgical incision is made and the spine is exposed either from the back which
is called a posterior approach or from the side which is called an anterior
approach. Rods are fixated to the spine from the direction of the approach.
Over the last 10 to 15 years, the use of anterior spinal procedures has
increased. These procedures involve approaching the patient from the side and
inserting the metal rods to support the spine. The rods are attached directly to
the vertebral bodies.
Most recently, instrumentation can be inserted using a
minimally invasive procedure called
thoracoscopy. Telescopic instruments are
inserted into the chest with the lung deflated and metal rods can be attached
to the vertebra without needing to make large incisions. The technique is useful for moderately large
curves in the chest, but is technically demanding and is best done by medical
centers with extensive experience in thoracoscopic work.Who should consider idiopathic scoliosis for idiopathic scoliosis and in what cases? Q: Patients who have a curve in the chest area where the
spine is tilted more than 50 degrees or are curved in the lower portion of the
back where the spine is tilted more than 40 to 45 degrees should consult a
spinal deformity specialist for information regarding surgical procedures, such
as spinal fusion.What happens if nothing is done for idiopathic scoliosis (best case/worst case scenarios)? In the best case, the scoliosis remains stable throughout
the patient’s adult life and creates no particular problems. This is especially
true for curves that are “borderline”.
If a child is finished growing and the curve in the chest is 50 to 60
degrees or if the curved lower portion of the back is 40 to 45 degrees and the
child is not experiencing symptoms or is not bothered by his or her back, it is
reasonable not to perform surgery on these patients.
The worse case scenario for scoliosis is that the deformity
will progress over time. If that occurs,
then delaying surgery is not recommended as the deformity can become quite
severe and increasingly difficult to manage.
Also, the risks of surgery will increase with an extremely large
deformity. What options exist for surgery for idiopathic scoliosis? As outlined above, conventional options include spinal
fusion through either a posterior or anterior approach. In some cases, a
combination of an anterior and posterior approach will be necessary to
effectively stabilize the back.
For very young children with scoliosis that is progressive
and for whom bracing has not been successful, stabilization of the back may be
done by inserting metal rods to support the spine without performing a spinal
fusion. This type of procedure is called
insertion of a “growing rod.” The rods
need to be elongated about every six months with surgery.
A newer method involving stapling of the spine to try to
modulate the growth is currently under review, but it is not yet approved for
general use. When performed by an experienced surgeon, how effective is idiopathic scoliosis for idiopathic scoliosis likely to be and how long will the benefit last? The success rate of stable fusion and correction of spinal
deformity is very high in experienced hands. The average curve correction is
approximately 70 percent and the likelihood of complications has been about 2
to 3 percent overall. The fusion of the bones (enabling the bones to grow
together) is permanent.
There are concerns about long-term degenerative arthritis
that may appear 30 to 50 years later in segments of the spine that were not
fused. Currently, there is not adequate follow-up information on the procedure
to know the frequency of this problem. How urgent is idiopathic scoliosis for idiopathic scoliosis? The urgency of spinal fusion is based on how rapidly the
curve is changing. For a child who is in
the early stages of their pubertal growth spurt, the spine can increase
deformity at a rate of up to 2 to 3 degrees per month, so while scoliosis
surgery is plainly not an emergency, neglecting rapidly progressive curves for
long periods of time is not a good idea
As an adult, or someone in the later stages of growth, the
rate of change will only be 1 to 2 degrees per year, therefore, the urgency is
less.
In general, waiting six months to a year is an acceptable
time to wait to have fusion surgery. What are the most frequent and most serious risks of idiopathic scoliosis for idiopathic scoliosis? How common are they? The most common risks of spinal fusion surgery for scoliosis
are:
1) Infection: risk of infection is approximately 1 to 3
percent for idiopathic scoliosis. There is an increasingly recognized
possibility that infection can occur for up to two to three years after the
initial procedure.
2) Failure of the
bone to fuse: the failure of the bones to grow together and heal with scar
tissue, rather than bone, occurs in 1 to 2 percent of cases in children. In these cases, repeat surgery will sometimes
have to be performed to get the bone to effectively grow together. This concern
may not be apparent for several years after the initial procedure.
3) Injury to the spinal cord resulting in partial or
permanent paralysis of the lower extremities: the risk of this injury has been
reported from 0.2 to 5 percent of cases depending upon where the procedure was
performed on the spine and the seriousness of the deformity that has been
treated. If risks occur during or after idiopathic scoliosis for idiopathic scoliosis how are they managed? Managing risks that occur involves the following:
1) Infections
following spinal fusion surgery are not generally life threatening to the
patient. They may require additional surgery to clean out the infection,
long-term use of antibiotics until the bones are solidly healed, and in some
cases, may require removal of the metal rods and implants to allow for final
treatment of the infection.
2) Problems with bone healing are best managed by having the
patient go back to the OR for a follow up procedure to re-stimulate the healing
process by surgically grafting bone to the area involved and replacing some of
the instrumentation used to stabilize the spine
3) Injuries to the
spinal cord that lead to paralysis with loss of lower limb function may require
removal of implants to relax the correction of the scoliosis. It is thought
that a blood flow problem to the spinal cord may be created. By relaxing the spine, tension will be
alleviated and this should help patients regain function. Eventually the spine
implants will have to be replaced but in a less “corrected” position. Surgery for Idiopathic Scoliosis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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