Scoliosis Surgery: Spinal Fusion
Spinal Fusion
Scoliosis surgery and surgery for other types of spinal deformities requires
the spine eventually to be fused solid as the current standard. Fusion is the
process where motion segments (vertebrae) are welded together using bone grafts.
Biologically speaking, the process of spinal fusion to completion takes three
months to one year. During that time, the progress of the fusion is evaluated
on x-rays.
Bone graft comes from different sources such as the pelvis (iliac crest of the hip), ribs, or the spine (local bone from the surgery site). Using local bone lessens the patient's pain caused by harvesting bone from other areas of the body. Allograft or cadaver bone is also often used and eliminates donor site morbidity. In addition, protein bone graft substitutes (BMPs) may be used in select cases such as when an established failure of fusion (pseudoarthrosis) has occurred.
Since smoking interferes with fusion, patients should make every effort to stop months before their surgery. Smoking cessation should continue after surgery.
Anterior-Posterior Approach (Front-Back)
The anterior-posterior approach is performed in patients with severe stiff curves
and in young, skeletally immature patients to prevent crankshaft phenomenon.
This procedure may be performed in one day or separated into two procedures
on different days.
Generally, one curve is approached from the front and back. If there is a second curve, it is approached only from the back. Sometimes, if there are two severe curves, a double anterior-posterior procedure is performed.
The anterior approach is the standard procedure performed to treat lumbar (low back) curves. Despite its name, it is actually performed through the patient's side to access the front of the spine. Anterior surgery can be performed using a scope inserted into the thoracic spine; also called thoracoscopic surgery.
The anterior-posterior approach is more involved than a single anterior or posterior procedure. Surgery may last six to 10 hours, the average hospital stay ranges between five days to two weeks, and recovery takes longer than a single approach procedure.
Anterior-Posterior Approach: Pediatric (below): Anterior-posterior (front-back) surgery was performed in one day. The anterior part of the surgery was performed using thoracoscopy with three one-inch incisions. Please note that the lumbar spine (low back) is mostly spared from fusion in this case.
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 After |
Anterior-Posterior Approach Adult (below): Adult Fusion was taken down to the sacrum (pelvic area) in this 57-year-old adult with back pain and disc degeneration.
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