Advancement in Surgical Treatment of Scoliosis

In the United States, scoliosis, an abnormal side-to-side curvature of the spine, is found in about 3% of the population primarily affecting girls during their pre-teen growth spurt. Some of the signs of scoliosis include:

• Uneven waist
  
• Body leaning to one side
  
• Uneven shoulders
  
• Head not centered over the pelvis
  
• One shoulder blade more prominent than the other

Many factors influence the treatment plan including the child's age, remaining growth potential, curve pattern and magnitude, anticipated rate of progression and appearance. Although bracing is the standard treatment to prevent curve progression and improve deformity, in some cases, surgery is necessary.

Different types of spine surgery are used to correct scoliosis. The surgical approach is either from the back of the spine (posterior) or the side (lateral decubitus). The goals of surgery include stabilization of spinal segments (i.e. vertebrae), deformity correction within safe parameters and to enhance spinal fusion.

This type of surgery involves spinal instrumentation and fusion. Spinal instrumentation is the use of screws, rods and other types of medical grade hardware to add structural support to the spine. Bone graft is used with spinal instrumentation to facilitate fusion; where bone grows around the instrumentation to hold it secure.

Traditional Open Spine Surgery versus Use of Endoscopes

Traditional open spine surgery for scoliosis leaves a large scar either down the center of the back or along the side of the chest wall. It is not difficult to understand why some patients find this the worst part of the surgery!

Dramatic advancements in spine surgery for the treatment of thoracic scoliosis are now utilizing minimally invasive techniques similar to those used in knee and abdominal surgeries. During the past 20 years the development of endoscopes, fiberoptic video cameras and other specially designed surgical tools have made it possible for surgery to be performed through small holes instead of large incisions.

In the mid-1990's George Picetti, MD, an orthopaedic surgeon, began to pioneer thoracoscopic instrumentation for the treatment of scoliosis using endoscopes. Endoscopes allow the surgeon to see inside the body and operate through small incisions called portals.

After years of research Dr. Picetti found endoscopic correction of scoliosis to be a viable alternative to the surgical treatment of certain scoliotic curves. This new technology is called the HORIZON CD HORIZON ECLIPSE™ Spinal System . CD HORIZON ECLIPSE™ Spinal System accomplishes the goals of a traditional open procedure with many potential advantages:

• Scars are dramatically less noticeable
  
• Blood loss during surgery is reduced
  
• Less disruption to the rib cage, muscles and other soft tissues
  
• Post-operative pain is lessened
  
• Fewer days are spent in the hospital
  
• Rehabilitation and recovery are easier and faster

This new development is exciting news for patients with progressive scoliosis!

Types of Scoliosis

There are many types of scoliosis and often the cause is not known. This is called Idiopathic Scoliosis. Generally, scoliotic curves are classified as either nonstructural or structural. Nonstructural scoliosis may be caused by muscle spasms, an inflammatory condition or a difference in leg length. Neuromuscular diseases such as muscular dystrophy or cerebral palsy may cause structural scoliosis. Birth defects, spinal tumors and other disorders are also known to effect structural scoliosis.

The type of scoliotic curve is a factor in the choice of surgery. Only a small percentage of patients with scoliosis have the type of curve that can be corrected with an endoscopic technique. Dr. Picetti indicates a very flexible, single right thoracic curve is the ideal curve for endoscopic instrumentation.

At this time, curves resulting from a neuromuscular disease or those with a great deal of kyphosis (bent forward) are difficult to treat with this new technique.

Just the Start

Although endoscopic instrumentation is currently limited to specific scoliotic curves, remember this technology for use in spine surgery is in its infancy! No doubt you will be reading about these marvelous advancements in the future as spine specialists spend time and energy on improving this new technology!