Spinal column has unique anatomy: its structure is the most complicated in human body. The bones comprising it – vertebrae – are interconnected by numerous joints and network of ligaments. As the result, a robust, flexible and mobile foundation of skeleton is formed.
While performing supporting function, the spinal cord ensures normal activity of all inner organs. It also protects the bone marrow – an irreplaceable part of the central nervous system, and is responsible for many other important processes and activities.
All anatomic alterations in the spine trigger changes of functionality of inner organs, which affects the entire body.
It’s crucial to underline the difference between simple disorders of the spine and scoliosis. The main symptom of scoliosis is crank of vertebrae called “torsion”.
There are multiple reasons for deformation of the spinal column, we will highlight four basic causes:
In case of considerable skeleton abnormalities, for instance, severe shortening of the lower limb, scoliosis may also develop. Here it should be viewed as an incorrect compensatory mechanism.
The vast majority of patients have scoliosis developing starting from the childhood. Weakened spine ligaments, incorrectly placed growth centers of corpus vertebrae may lead to scoliotic changes.
When a kid starts attending school, routine daily activities pose huge load on the back – the backpack with books, static posture during writing, etc. Pretty often, this load triggers spine deformations in children from risk groups: the ones who have hormonal disorders, or inborn abnormalities of bone-ligamental apparatus.
In an average person, the growth of the skeleton ceases by 20-22 years. Therefore, real progression of scoliosis is untypical for adults. People with long-lasting condition have symptoms of chronic scoliosis:
These are crucial peculiarities that should be taken into account to perform an efficient rachilysis surgery. Therefore, surgical techniques are divided into two major categories: operations on a growing spinal cord, and operations on a formed spinal cord.
In layman’s terms, some methods are suitable for children and teenagers while the others are better for adults.
Treatment of scoliosis is a real challenge. It’s better to start treating the condition at its early stages that are classified according to the angle of spine deformation and misplacement from the vertical axe.
Many different operations for scoliosis can be performed. All of them are combined by six basic methods:
By anatomical principle, operations can be performed on the front or the back part of the spine. There are different indications, peculiarities of accessing, and methods of straightening for both approaches.
A certain method is figured out individually for every patient. Many different factors are taken into account, and patient’s age is the basic one.Surgical treatment helps to solve various problems, including:
A remedial surgical procedure for scoliosis treatment is a must, when the angle of spinal misplacement from the vertical axe is 50 ° and more.
The fourth degree of spinal deformation usually means that conservative and physical therapy treatments appeared to be useless. This is why surgical invasion is inevitable.
Elimination of spinal deformations is made with the help of special constructions and posts. Adult patients usually have immovable constructions installed – they keep vertebrae in the right position. Children and teenagers whose spine is continuously growing need expensive movable constructions that can grow together with bones. There are many different methods for scoliosis treatment. Some of the most widespread are:
A classic operation is called “posterior spine fusion”. This technique is widely spread among orthopedic surgeons and is greatly researched. It is aimed at making a rigid immovable structure from several vertebrae and ceasing deformation in the corresponding spinal department.
Indications for the operation – scoliosis with high mobility of vertebrae, when their anatomical structure should be preserved.
In some cases, this operation can also be prescribed for rigid forms of scoliosis when vertebrae do not move much. As a rule, it concerns young people who:
In this instance, spondylosyndesis helps to form an immovable bone block in projection of body center of gravity. It also helps to prevent further deformation of spine arc under intervertebral osteochondrosis and sinking of intervertebral discs.
To have this operation indicated, a person should prepare the spinal cord. This procedure is aimed at strengthening the spine and fixing it at some certain position with orthopedic surgeons’ help.
The choice of certain method, duration of procedure, and peculiarities of preparation depend on overall health and characteristics of scoliosis in every single patient.
During pre-operational period, doctors manage to reduce the angle of spinal deformation by 10-20 degrees.
In a weak point of the spine, a rigid block is fixed: it does not allow the spine to deform further on. Progression of scoliosis is ceased.
The operation implies installation of a vertical transplant made of patient’s own bone in the spine. It is installed by the hollow (inner) side of curvature arc.
Patients and simple readers won’t find detailed description of posterior spine fusion operation interesting. But we should mention its basic stages:
As a rule, a fragment of patient’s own shin bone serves as material for transplantation. Sometimes surgeons only apply bone chips into the formed bed. When the transplant is fixed, it is covered with muscles that were separated on the second stage.
Since the thick cortical bone is removed, all bone formations and the transplant contact with each other via a spongeous bone and grow together rigidly.
It’s crucial to have the transplant located along the projection of centre of gravity of the curved spinal cord. Only this way you can fix the block and make sure it won’t move along high and low parts of the spinal cord.
When rigid (immobile, static) scoliosis is developed, a posterior spine fusion surgery won’t be efficient enough. In such cases, the present curvature should be eliminated first, and the new rigid vertebral block should be formed after that.
Initially, metal constructions were used for spinal straightening – they were called “distractors” and worked by the principle of an adjustable jack. The problem is that they should be removed some time later, and such operation is very traumatic.
A coarse-meshed polyethyleneterephthalate (lavsan) band can be used as an alternative to a temporary metal distractor – it may not be removed.
S-shaped thoracolumbar scoliosis is the main indication for such type of operation. It is aimed at correcting and stabilizing the spinal cord in the lumbar spine.
The band maintains dragging aimed at straightening the bulging of scoliosis arch – it does not have to be removed. After the operation, a patient is put into a corrective plaster bed for 3 months.
After that, a plaster bed is replaced by a plaster jacket that should be worn. It is also used for 3 months. If new operations are not required anymore, the plaster jacket can be replaced by an orthopedic removable jacket that must be worn for at least a year.
This operation is aimed at making vertebrae move in certain direction.
First, processus transversus are bared. When a surgery on the thoracic section is performed, all adjacent parts of ribs are removed, but periosteal coverage is preserved.
Therefore, invertebral discs are bared. Annulus fibrosis of several discs is cut from the arched side. At this side, an homeotransplant (bone chips made of removed rib parts) is put. After the operation, a patient should rest for at least 12 months. Plaster constructions are used for that.
This is a suitable spine surgery method for progressing scoliosis in childhood. The approach is called “episiodesis”. It is aimed at destroying growth zones of bodies of vertebrae from the bulging side.
Pretty often, it is indicated in case of breast hunch. Just like during discotomy, lateral surface of vertebrae is bared, but from the bulging side.
Removal of part of disc is performed the following way. Its widest part is the object for resection only. Nucleus pulposus is always removed. The defects between vertebrae are closed with bone chips made of deleted ribs.
After the operation, a patient should use a plaster bed until the stitches are removed. After that – a plaster jacket with headholder should be worn for 2 months. Then an X-ray imaging of the operated area is made. If everything is okay, the jacket for horizontal position is put off, and a jacket for walking is given.
This is rather an additional technique that is used for treatment of serious forms of scoliosis. Main indication – rigid (solid) scoliotic deformation of the spinal cord.
The surgery implies removal of the wide part of vertebrae on the bulging side (sometimes several vertebrae are operated). To preserve normal proportions of the spinal cord, fragments on the narrowed part and the back part of the spinal cord are removed, as well.
Key stages of this operation are the same as for discotomy and episiodis. Recovery and post-surgical care are also similar.
All above-mentioned and some other operations with similar approaches have a few disadvantages. The most serious cons are necessity to remove a lot of tissues, and long-term recovery process. Classic methods of scoliosis treatment affect the quality of life and require at least a year for recovery.
Modern methods of surgical treatment of scoliosis are different from the ones that were used in the 20th century. The main differences are:
Evolution of distractor method lies in the base of such operations.
Today, many orthopedic clinic allow installing low-traumatic metal constructions on the spinal cord. The principles of such operations are similar, only minor details differ. The main principle is the following:
Since transpedicle screws are installed at both sides of the spinal cord, and guides are bilateral and can be rendered any shape, the spinal cord is straightened symmetrically.
The main benefit of spinal constructions is that the guiding element can be moved in front-back body axis while the patient is growing.
The entire spinal construction is placed under back skin and almost does not interfere with normal life. When the spinal cord stops growing, the construction can be removed.
A patient after operation can need additional dragging while the block is growing together. However, stretching jackets should not necessarily be worn right after the operation.
It’s recommended to wait for 10-12 days to make sure that the wound after surgery is healing well and without complications. After that, a plaster jacket with head holder can be fixed.
A patient should wear a jacket for up to 4 months staying in bed rest. Therefore, the patient and family members should prepare for post-surgery care beforehand. 16 weeks after the operation, a patient is allowed to walk.
In 7-8th month, the plaster jacket is put off and replaced by a usual orthopedic one. If the operation was performed on the upper thoracic spine or thoracocervical spine, a head holder is typically used. Patients usually wear them for about a year.
Before the jacket can be removed, patient’s well-being is examined. The following aspects are evaluated:
X-ray imaging, computer tomography, and magnetic resonance tomography allow getting a lot of useful information about patient’s health. Plaster jacket cannot be removed without these analyses.