Scoliosis Spinal Fusion Surgery: What to expect
Scoliosis surgery is often recommended when the scoliosis Cobb angle reaches or exceeds 40 degrees. The most common and widely prescribed surgery is spinal fusion surgery. As tempting as it might be, it is important to remember that there is no quick fix for scoliosis, surgically or non-surgically.
What is Spinal Fusion Surgery?
Spinal fusion surgery is the most invasive scoliosis treatment of all of the options available. It entails making an incision down the back along the spine. The next step is to expose the spinal bone by cutting away the posterior spinal muscles from the bone along the areas of the severe curvature that need to be fused. Once the muscles are detached and the spine is visible, some remaining contractures might need to be removed as well.
Contractures consist of ligament, muscle, or disc that have grown asymmetrically and become stiff because they were stuck in a scoliotic posture preventing them from exercising their full range of motion. After the contractures have been surgically excised, the facet joints must be chiseled out as well. By removing the contractures and the facet joints, the surgeon is able to make room for the spine to be straightened.
The next step is to insert pedicle screws by drilling holes into the spinal vertebrae. After the screws are in place, steel rods are inserted through the screw heads. The spine is then straightened to the limit of the tight spinal cord.
The spinal cord is often the main limiting factor inhibiting surgical straightening of the spine. Straightening the spine elongates the spinal canal which houses the spinal cord. So as the spine is straightened, the short spinal cord, common in most scoliosis cases, becomes stretched into a longer position. Dr. Renske, a pediatric orthopedic surgeon at Stanford claimed, “I could make every spine perfectly straight if it wasn’t for the tight spinal cord.” Among surgeons, it is known that the short, tight spinal cord is what sets the limit for how straight scoliosis can be surgically made. This is a key reason why the neurologic function is closely monitored during the straightening process of a scoliosis fusion surgery; to avoid overstretching of the spinal cord.
Once the spine is straightened to the limit of the short spinal cord, the vertebrae must be fused together by tightening the screws to the rods and inserting bone graft between the vertebrae. A successful fusion should limit 100 percent of the mobility within the fused segments. After that, the muscles that were removed tend to become fibrous scar tissue since their insertion point was removed. Lastly, the back is stitched up. While this marks the end of the surgical procedure, the recuperation period can be quite long even if no complications arise.
Complications of Spinal Fusion Surgery
Many surgeons will claim that the surgical procedure and recuperation can be completed in as little as 6 months. However, a 2017 study published in the European Journal of Pain found that a whopping 42% of children had pain from scoliosis surgery over a year later.1 It is difficult to provide a specific percentage of recuperation time and complication rate in part because there is no mandatory reporting protocol in place for scoliosis surgery. This is because the Scoliosis Research Society (SRS) does collect data regarding the complication rates of scoliosis surgery but surgeons can opt out of reporting by paying $200 a year. The complication rates reported by the SRS range from 5 to 20%.
However, in a study conducted by Hans-Rudolf Weiss and Deborah Goodall in 2008, a search revealed 2590 titles associated with the words “surgery”, “scoliosis”, and “complications”. Among those terms, the rates of complication varied between 0 and as much as 89%. The study later concluded that no definitive complication rate could be defined due to a lack of standardized reporting for the long-term. Thus, according to Weiss, “the rate of complications may even be higher than reported [89%]”2.
Among the complications that were recorded, the risks of spinal fusion included severe blood loss; urinary infections due to catheterization; pancreatitis; obstructive bowel dysfunction due to immobilization during and after surgery, curvature progression, increased torso deformity, re-operations, gastrointestinal bleeding, blindness due to central retinal artery occlusion, kidney failure, nerve root injury, recurrent meningitis, chronic intermittent vomiting, and death2. The death rate was the hardest of the complications to report on due to attributing whether or not it was related specifically to the operation or another medical issue. For more information on the death rates of scoliosis surgery view the scoliosis surgery death rate statistics.
Although spinal fusion surgery, in particular, is frequently recommended for scoliosis curves that are 40 degrees and above, it is not the only option. In fact, as Weiss claimed, “no evidence can be derived that supports the assumption that patients have experienced benefits from undergoing surgery3”. There is no going back from scoliosis fusion surgery, yet it is often made out to be a shining end-all solution proposed by surgeons. It is important to bear in mind that the complications that arise from the surgery can also be permanent. This is why Scoliosis Care Centers has placed such an emphasis on providing a successful non-surgical alternative for scoliosis treatment.
1. Chidambaran V, Ding L, Moore DL, et al. Predicting the pain continuum after adolescent idiopathic scoliosis surgery, A prospective cohort study. Eur J Pain 2017;21:1252–65.
2. Weiss H-R, Goodall D. Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis 2008;3:9.
3. Weiss H-R, Bess S, Wong MS, Patel V, Goodall D, Burger E. Adolescent idiopathic scoliosis – to operate or not? A debate article. Patient Saf Surg 2008;2:25.