Spinal Deformity Reconstruction
Description of Spinal Deformity and Spinal Reconstruction
There are a variety of ways in which a spine may be misshapen, because of scoliosis, kyphosis, Scheuermann’s disease and other problems. In such spinal deformity patients, the spine is curved from side to side, rotated and/or curved forward too much. There are many ways to reconstruct a curved spine. The type of surgery for spinal reconstruction depends on the degree of the curve, where the curve is located within the spine, patient age, patient general health and other factors. Spinal reconstruction generally involves the use of screws, hooks or wires put into the vertebral bodies. The curve is then straightened as much as possible by attaching a rod to the attachment points. Sometimes an interbody fusion is also performed. This may be performed using minimally invasive techniques. The fusion helps to shape the spine and/or make it stable.
Conditions Treated with Spinal Reconstruction
Spinal deformity reconstruction is used to treat a wide variety of conditions that result in the spine being misshapen; these include scoliosis, kyphosis, Scheuermann’s disease and others.
While there are many different ways to reconstruct the spine, the exact surgery for spinal deformity performed will depend primarily on the location and severity of the curve(s). Described below are general descriptions for anterior interbody fusion (ALIF) and posterior lumbar fusion(PLF) with pedicle screws. If a large number of levels of the spine are involved, the front and back side surgeries may be done on separate days.
What to Expect Before Spinal Deformity Reconstruction
Once you have decided to have surgery, the following events take place:
- A medical examination.
- Chest X-ray, EKG and blood work.
- You may be asked to have a neurological or psychological examination.
- If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before surgery.
- If you take prescription medications or other drugs, including herbals, ask your doctor how soon before surgery you should stop taking these.
- Do not have anything to eat or drink for 6 to 8 hours before surgery.
- You will check into the hospital the morning of the spinal deformity reconstruction surgery.
- Prior to surgery, you will be asked to sign permits for surgery, anesthesia, blood and blood products.
What to Expect During the Spinal Deformity Reconstruction
(Described below is surgery involving fusing the front and back of the spine, a 360° fusion.)
- An incision is made by a general surgeon in the abdomen to expose the front part of the spine.
- Fluoroscopy (live x-ray) is used to determine the correct level(s) to be operated.
- The disc is approached after carefully separating away the abdominal contents and major blood vessels are moved off to the side.
- The disc is removed.
- A fusion cage or wedge of bone is placed in the disc space.
- Normal compression of the spine will hold the bone or cage in place. A screw may be placed into the vertebrae to act as additional fixation.
- After the anterior fusion is completed and the incision closed and bandaged, you will be gently rolled over on the operating room table and prepared for the posterior lumbar fusion.
- An incision is made in the low back area.
- Fluoroscopy is used to determine the correct levels to be operated on.
- Bone graft is placed along both sides of the back part of the spine.
- Pedicle screws and other attachment devices are placed in the vertebrae in the curved region.
- The screws are connected with rods (this is done to help straighten the spine and make it stable).
- Surgery takes approximately 4-8 hours.
What to Expect After Spinal Deformity Reconstruction
- You will be in the recovery room from 1 to 1½ hours.
- The surgeon will contact your family while you are in recovery.
- After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
- Staff will usually get you out of bed shortly after surgery.
- The hospital stay is usually 3 to 10 days (the upper end of this range generally applies to patients in whom many segments of the spine were operated).
- A brace is prescribed to restrict bending and promote healing of the fused area.
- You will be given any needed prescriptions and discharge instructions.
- A set of exercises that you can do at home will be provided.
- You will be able to ride in a car or plane upon leaving the hospital.
- It is important to avoid twisting and bending backward.
- Physical therapy is usually prescribed after surgery to help strengthen muscles.
Recovery from spinal reconstruction varies greatly among patients and is dependent on the extent of the surgery as well as the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do.