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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!
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