How can corrective surgery treat scoliosis
Q: What are the types of corrective surgery for scoliosis? Lou Zhaohui, Department of Orthopedics, Zhengzhou University First Affiliated Hospital
A: We often refer to corrective surgery as corrective fusion surgery. Corrective fusion surgery is the placement of a metal nail bar stent in the body, which straightens and maintains the curved spine and is equivalent to a metal brace placed in the body. It is not enough to rely on the stent alone to maintain the spine, but the surgery is accompanied by bone grafting, which is the placement of granular bone on the dorsal side of the spine, which will hold the spine in place after it heals, just like welding the spine. So, in fact, the metal brace loses its role in supporting the spine about six months after surgery, and the maintenance of spinal curvature then depends mainly on the fused granular bone.
In addition to corrective fusion surgery, there are some special types of scoliosis surgery, including hemivertebrectomy, growth bars and minimally invasive navigation surgery.
Q: What does hemivertebrectomy mean?
A: Hemivertebrae means half of a vertebra. It is the most common form of congenital scoliosis. Normal vertebrae are symmetrical on the left and right side, while hemivertebrae are only on the left or right side, and the other side is not growing out. Our spine contains 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae, one falling on top of the other. If one of these sections is asymmetrical on the left or right side it will affect the overall shape. A hemivertebrectomy is the removal of this abnormal vertebrae, which is then fixed with a nail bar, and the treatment is completed by removing the nail bar after 2-3 years.
Q: What does a growth rod mean?
A: Growth rods are used for early onset scoliosis, which is a significant scoliosis before the age of 10. Children before the age of 10 should not have corrective fusion surgery because once corrective fusion surgery is done, the child’s trunk will be fixed in length, and the trunk of the child at this age still has growth potential until the age of 18, premature fusion will lose the child’s height, and because the lower extremities are still growing, the ratio of the trunk to the lower extremities in adulthood The ratio of the trunk to the lower extremities can also be out of proportion. To address this problem, doctors have developed the growth rod technique. This is a surgical procedure in which a metal stent is placed through three small incisions in the upper and middle of the body. This metal stent corrects scoliosis and allows for a minor surgery to lengthen it every year. This buys valuable time for the child to undergo the final corrective fusion surgery after the child is 12 years old, greatly improving the outcome.
Q: What about minimally invasive navigation surgery?
A: Minimally invasive navigation is a breakthrough achieved in recent years. It is based on the latest type of navigation equipment, combined with innovations in surgical techniques, and requires only three 5 cm incisions to complete a procedure that previously required a 40 cm incision for acquired scoliosis of 90 degrees or less.
Previously, scoliosis orthopedics was considered a highly invasive and risky procedure. The advent of navigation devices has significantly changed this situation. First of all, traditional surgery is very invasive because the spine has to be clearly exposed before the screws can be placed, because traditional surgery relies on anatomical landmarks and the surgeon’s experience to place the screws. In contrast, navigation surgery is not necessary, as navigation screw placement relies on intraoperative CT, which does not require direct visualization of the anatomical landmarks of the spine, thus greatly reducing the incision and the damage to the back muscles. In addition to the risks, spine surgery was previously considered high risk because of the dense neurovascularity near the spine. The advent of navigation devices has greatly increased the safety of surgery, as the screen of the navigation device shows exactly where the blood vessels are and where the nerves are, reducing the chances of injury to the vessels and nerves. Therefore, the application of navigation makes the scoliosis surgery less damaging and safer.
In addition, minimally invasive navigation can also correct cervical scoliosis because navigation can place the cervical arch nail, which was difficult to do before without navigation, so cervical scoliosis can also be corrected.
What patients should know before scoliosis surgery
Q: How much can scoliosis be corrected with surgery?
A: The degree of correction of scoliosis depends mainly on the flexibility of the scoliosis itself. The more flexible the scoliosis, the greater the degree of correction. Usually, the younger the age, the greater the flexibility and the better the correction, so the best age for scoliosis surgery is 13-15 years old. At this age, the flexibility of the spine is good, the correction effect is good, and the body is close to developmental maturity, comprehensive consideration of the most suitable for this age correction. The age of young mild to moderate scoliosis correction 80-90% are not a problem, severe scoliosis, very stiff scoliosis is more difficult, but correction of 50% should not be a problem.
Q: What is the best age for scoliosis surgery?
A: The best age for hemivertebrae is 3-5 years old. In other words, if the scoliosis is obvious at age 3 and exceeds 40 degrees, you can have surgery. If the degree is not too big at age 3, such as only 10-20 degrees, then you can wait a few more years and have surgery when you are 5-6 years old. In any case, you can receive surgery after the age of 3. The best age for adolescent idiopathic scoliosis surgery is 13-16 years old, when the bones are nearing maturity and still relatively soft, which is the best age for correction.
Q: Do I need any preparation before scoliosis surgery?
A: Current surgical techniques do not require special preparation before surgery, although it is beneficial to have a period of supplemental nutrition and physical exercise, such as swimming, running, or climbing stairs, for a faster recovery before surgery. Patients with severe scoliosis will need to do spirometry under the guidance of their doctor.
Q: When do I need pre-surgical traction?
A: Traction is generally needed for severe scoliosis, which means more than 100 degrees, and in addition to scoliosis, there is also kyphosis, and it is very stiff, so the doctor feels that it is difficult to guarantee the effect of one correction risk. Traction is generally cephalopelvic ring traction. The disadvantage of traction is that it is time-consuming, often taking several months, and the patient suffers more. However, the advantage is that it is safe and the final result is good.
Q: What is neuromonitoring?
A: Nerve monitoring allows for real-time monitoring of nerve signals, so that if there is a trend of nerve damage, it can be detected first and surgical strategies can be changed early to avoid permanent nerve damage.
Q: Do I need blood transfusion for corrective fusion surgery?
A: Many hospitals currently have blood transfusion techniques and teams. Unless the scoliosis is orthopedic on 100 degrees, there is usually no need to transfuse someone else’s blood.
Q: Which is better, imported spinal internal fixation materials or domestic materials?
A: This question is not too important, domestic Weigao is very suitable for scoliosis orthopedic, perfect tools, accessories are also complete, on the contrary, many imported brand screws do not have this advantage.
The most important details for scoliosis patients after surgery
Q: How should I treat pain after surgery?
A: Nowadays, the anesthesiology department has advanced PCA technology (Patient Controlled Analgesia), which allows patients to control the use of pain medication according to the pain situation, and with this technology, patients usually return to normal soon after surgery, which greatly reduces the pain felt after scoliosis surgery.
Q: How soon can I drink and eat after surgery?
A: Scoliosis orthopedic surgery usually has no effect on diet. You can usually eat 6 hours after you are fully awake from anesthesia.
Q: How long after surgery can I get up and walk on the floor?
A: Generally, you can walk on the ground under the protection of braces 3-5 days after surgery, and you can be discharged from the hospital 7-10 days after surgery, and when you are discharged from the hospital, you can basically take care of yourself, and you can sit up to eat and go to the bathroom by yourself.
Q: When can I take a bath after surgery?
A: You can take a bath after the wound heals, usually about 10 days after surgery. It is recommended that you take a shower and be protected by a family member to avoid falling.
Q: How long after surgery can I go back to school or work?
A: About one month after scoliosis orthopedic surgery, you can go to work and school under the protection of a brace after your strength has been satisfactorily restored.
Q: How long after scoliosis surgery can I play strenuous sports?
A: Generally, you can exercise vigorously six months after surgery. By this time, the granular bones have healed and the spine is very strong, so strenuous exercise will not have any effect.
Q: Can I bend my back after scoliosis surgery?
A: It depends on the scope of the surgery. If the surgery involves only the thoracic spine, there will be little effect on bending. Because normal people have no mobility in the thoracic spine due to rib fixation, there is no mobility in the thoracic spine after scoliosis surgery, just like normal people. If the surgery involves the lumbar spine, it will have a certain impact on the bending, but there will not be a situation where you can’t bend your back. Because bending depends mainly on the hip joint and only partially on the lumbar spine, even if all five lumbar vertebrae are fixed, it is still possible to bend.
Q: Can I still get pregnant if I have scoliosis surgery?
A: Orthopedic spine surgery generally does not affect a patient’s ability to become pregnant. On the contrary, scoliosis surgery can also improve trunk collapse and increase pelvic volume, which is beneficial for pregnancy, so it is best to have scoliosis surgery before pregnancy.
Q: When is the wound stitches removed?
A: At present, many hospitals use absorbable intradermal sutures, and the sutures are not visible on the wound surface and do not need to be removed.
Q: How long do I need to wear the brace?
Generally, you can stop wearing the brace after 3 months of post-operative follow-up if there is no abnormality.
Q: Do I need to remove the metal stent inserted after surgery?
A: Since the stent is made of titanium alloy, it does not interact with your own tissues, so it does not cause adverse reactions in your body and can therefore be left in place for life. Even if the stent is removed for some reason, the corrected spine will not be re-curved because of the removal of the stent, because the fused granular bone maintains the shape of the spine.
Q: How long after surgery do I have to return to the hospital for follow-up?
A: Generally, we will take a film once at 3 months, once at 1 year and once at 2 years after the surgery for the doctor to see. If it is inconvenient for out-of-state patients, the films can be taken locally and sent to you, or you can send them by WeChat or QQ.