Pre-operative x-rays
The Spine Exposed Scoliosis surgery in Brunei
In early July 2007, the department of Neurosurgery RIPAS hospital had organised for the first time Scoliosis surgery to be undertaken in the country. A Professor of Orthopaedic Surgery with a specialist interest in Spine from India was brought into the country through sponsorship of a drug company and performed 3 Scoliosis surgery with the help of our Neurosugeons.
A little bit about Scoliosis surgery:
Surgery for scoliosis is only recommended for patients with curves that are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. The main objective of scoliosis surgery is to fuse the spine so that the curve will not continue to progress into adulthood.
Only more severe curvatures (greater than 50 degrees) are likely to progress in adulthood. If a curve is allowed to progress to 70 - 90 degrees, it will not only result in a very disfiguring deformity, but will start to result in cardiopulmonary compromise. This happens because the curve in the spine rotates the chest and closes down the space available for the lungs and heart.
Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together.
Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.
Following scoliosis surgery, patients can usually start to move around about 2 to 3 days after the surgery and when they start feeling better, and total hospital stay is usually about 4 to 7 days. Patients can return to school about 2 to 4 weeks after surgery, but their activity needs to be limited while the bone is fusing.
It is important to note that the more immobile the spine is kept the better it will fuse. Bending, lifting, and twisting are all discouraged for the first three months after surgery. For this reason, some surgeons will prescribe wearing a back brace for a period following the surgery. Any physical contact or jarring type activities are restricted for about 6 to 12 months after surgery.
Generally the patient will be monitored with intermittent examinations and x-rays for 1 to 2 years after the surgery. Once the bone is solidly fused no further treatment is required.
For the most part, patients can resume normal activity levels after a thoracic fusion since fusing the thoracic and upper lumbar spine does not change the biomechanics of the spine all that much. Female patients who have had a scoliosis fusion can still become pregnant and deliver babies vaginally.
adapted from spine-health.com
3 comments:
Is it safe having the scoliosis surgery?
This is not to frighten, but to provide some information about the potential risks of surgery. Keep in mind, the majority of patients who undergo surgery do so without serious complications. Several potential problems are outlined below.
Neurological risk: The risk of injury to the spinal cord or nerves is very small; less than 0.5% in most cases. This risk is minimized by using spinal cord monitoring during surgery. A specialist continuously observes electrical signals in the spinal cord and nerves during surgery and reports changes to the surgeon. Spinal cord monitoring also allows the surgeon to assess how much curvature correction is safe. Both sensory and motor (movement) tracts of the spinal cord are monitored so that a complete picture is available to the surgeon almost instantaneously.
Bleeding: Bleeding occurs during all major surgery. However, bleeding is kept to a minimum by careful surgical technique and hypotensive anesthesia (low blood pressure anesthesia technique). Blood pressure is lowered but kept in a safe range for the patient. In a more advanced setting (not available in RIPAS yet),Cell saver is used to collect blood in the operative field, filter and wash it, and then immediately return it to the patient. If the patient donates blood before the surgery, they are unlikely to receive a blood transfusion from the community blood bank in most cases.
Infection: The risk of a wound infection is low. Antibiotics are given before, during and after surgery to minimize this risk. If an infection does develop, it might require an operative procedure to cleanse the wound followed by a period of antibiotics given intravenously and / or orally.
Instrumentation problems: The risk of an implant becoming loose or breaking is low. If such a problem developed, a relatively small procedure could be performed to revise the instrumentation.
Blood clots: Blood clots are uncommon after spine surgery. The concern about blood clots is their potential to dislodge and move to the lungs blocking normal oxygenation of the blood stream. Special stockings (TED stockings, Thrombo-Embolic Deterrent) and compression wraps are worn by the patient in the hospital to reduce the risk. Mobilizing the patient out of bed and having them exercise their legs when in bed and out also lowers this risk.
Anesthesia complications: The anesthesiologist speaks to the patient about their personal risk the day of surgery. If the patient has a significant medical condition, they will meet with the anesthesiologist before the surgery date.
adapted from www.spineuniverse.com
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