SCOLIOSIS SURGERY

What is the goal of surgical treatment of scoliosis?

The aim of scoliosis surgery is to align the bent vertebrae in a proper (physiologic in the anterior, posterior, lateral and axial planes) and fuse them together (fusion surgery). After fusion, this area moves as a single bone (vertebra).  

Who needs surgical treatment for scoliosis? 

In general, curvatures above 45-50 degrees continue to progress even after puberty ends and growth is complete. Progression can create an aesthetically unpleasant appearance on the back and waist, as well as impair lung function. In this case, most doctors who perform scoliosis surgery prefer surgical treatment to reduce the scoliosis curvature or to prevent it from increasing.  

Patients with curves between 40-50 degrees are sometimes offered different treatments, what is the reason for this?

If a growing child has a scoliosis curve between 40-50 degrees, surgery should be decided after evaluating many factors. It is best to decide on surgery after discussion with an experienced spine surgeon.   

How successful is scoliosis surgery?

Today's technology has increased the ability of scoliosis surgeons to correct curvatures. Thus, an aesthetically correct appearance can be achieved. Fusion surgery, in which the curved vertebrae are fused together, is very successful in preventing the scoliosis curvature from increasing.  

How much does the curve improve after scoliosis surgery?

The vertebrae are also responsible for protecting the spinal cord. Therefore, during surgery, they try to achieve the maximum correction that is safe to avoid damaging the spinal cord.  

Is it possible to understand how much the scoliosis will improve before surgery?

Before surgery, special X-rays, called special tilt or traction films, are used to understand how flexible the scoliosis curve is. The surgeon who will perform the surgery has an idea about the flexibility by measuring with these films. The more flexible the scoliosis curve is, the more improvement is achieved. 

Where and how big a skin incision is needed for scoliosis surgery? 

Scoliosis surgery is usually performed through a skin incision made in a straight line in the middle of the back. The length of the skin incision is two to three centimeters longer than the distance between the scoliosis and the vertebrae to be corrected. 

Does back pain decrease after scoliosis surgery?

In the early postoperative period, back and lower back pain is more severe than in the preoperative period. However, this pain decreases within a few weeks - months. In general, after 1 year, most patients say that they have less pain after surgery than before surgery.  

How does fusion surgery affect scoliosis?

Fusion surgery completely stops the growth in the abnormal area of the spine and prevents the scoliosis curvature from increasing. 

How to fuse the vertebrae together?

Small pieces of bone (grafts) are placed into the joints between the vertebrae to fuse them together. The joints between the vertebrae fuse (fusion) in the same way as the ends of a fracture fuse together.  

Does fusion surgery eliminate back and lumbar movement? 

The fused area of the spine remains immobilized for life. It is therefore important to correct the scoliotic curvature by fusing as few vertebrae together as possible. After surgery, most patients have enough mobile vertebrae to bend and stand up. The vertebrae that are not fused together reach enough movement and flexibility to perform many sports within a year. 

Can scoliosis be corrected without fusion?

The dream of all doctors dealing with scoliosis is to find a treatment that corrects the scoliosis while preserving normal vertebral motion. However, all current surgical treatments result in some reduction in spinal motion when the scoliosis is corrected.

What are the metal screws and rods inserted during surgery for?

Metal screws and rods are used in scoliosis surgery to transfer the force and surgical maneuvers required for correction to the spine and hold it in that position until fusion occurs. The screws are inserted from the back to the front of the vertebrae into the pedicles, two in each vertebra. Rods are inserted into the spaces inside the screws. These metal parts are usually made of titanium or stainless steel.  

Do the screws and rods used in surgery stay in the body for life?

Screws and rods used in scoliosis surgery do not need to be removed. However, they may need to be removed in rare cases such as infection or breakage of the rods. 

How to decide how much vertebrae to boil?

This is a situation that needs to be evaluated differently in each scoliosis patient. However, fusing as few vertebrae as possible positively affects the mobility of patients after surgery. Therefore, scoliosis surgeons plan the surgery by taking special films before surgery. During the operation, they try to fuse a small number of vertebrae together by using all scoliosis-correcting maneuvers.  

What is a bone graft used for?

Bone grafting is used to increase bone fusion. It increases bone formation (fusion) between the vertebral joints. There are three types of bone graft. Autograft; it is usually taken from the back of the pelvis in scoliosis surgeries. It is not used as much as it used to be because it prolongs the operation time, requires a second surgical site for the graft and creates a painful second site after the operation. Allografts are processed and prepared from cadaveric bones by bone banks. Today, their reliability in terms of sterility has increased and their use is frequent. Bone grafts made from artificial or marine coral are a third alternative.

 How long does scoliosis surgery take?

Depending on the length of the scoliosis curve and the number of vertebrae that need to be fused together, scoliosis surgery can take between 4 and 8 hours.  

Is there a lot of pain after scoliosis surgery?

The amount of pain may vary according to the person's pain threshold. There are also patients who say that they have no pain at all after the surgery or that they have extreme pain. Scoliosis surgery is a major operation in which the spine is repositioned and the muscles are replaced. Generally, the pain is more in the first days after the surgery, but in most patients the pain decreases after the third day and they are discharged. The pain then gradually decreases further and usually after two to four weeks school-age children can go back to school. Some patients may have pain that can be managed with mild painkillers for up to 6 weeks. 

 When can I start walking after scoliosis surgery?

Patients are up and walking on the second postoperative day. 

What should not be done after surgery?

Patients are usually asked not to bend too much and not to lift heavy loads for 3 months. 

 Are there any restrictions on sports after surgery?

At the end of the second month, patients can start sports that are not too heavy such as swimming, light jogging, cycling. Most patients are not prevented from practicing the sports they practiced before surgery. Heavy sports or sports that require body contact (soccer, weight training) are usually allowed after the sixth month. The reason for this six-month restriction is that a complete fusion of the spine usually does not occur before six months.