Health Information

Idiopathic Scoliosis Surgery Options

Our expert spinal surgery team provides the expert evaluation and surgical treatment that can help your child with scoliosis lead a normal life. For children with scoliosis as a result of cerebral palsy, sitting balance may be noticeably improved after spinal fusion.

Posterior instrumentation and spinal fusion

This procedure is most often done for idiopathic scoliosis, the most common type of scoliosis in children. We perform this operation under general anesthesia, so that your child won't feel it or remember it.

In this procedure, the deformed part of the spine is corrected and stabilized with two long metal rods. Each rod is placed on either side of the spinal midline (see Figure 1). To provide a permanent correction, we also perform spinal arthrodesis (fusion). Arthrodesis is the surgical fusion (welding) of the bones of a joint. In this operation, we use grafted bone, which can be taken from the patient's pelvis or ribs, or bone graft substitutes. Often, we use both — a combination of the patient's bone and a bone graft expander.

Before placing the rods, the surgeon shapes them to provide as normal as possible contours for the spine. Then, with the patient fully anesthetized in our state-of-the-art operating rooms, we attach the rods to the spinal vertebrae (bones) with multiple anchors. The anchors are metal implants specially designed for attachment, and may be hooks, wires, or small screws. During the process of attaching the anchor implants to the contoured rods, the spine is gradually straightened (see Figure 2).

Near the ends of this segment of the spine, the two rods are linked together with cross-linking implants. This provides additional stability and permits early mobilization, usually without a brace.

Although the rods and other spinal implants can be removed, they generally are left in place unless there is a specific reason to remove them.

The medical team will explain any activity that needs to be restricted right after the surgery. Once healing has occurred, the implanted rods will not affect a patient's mobility. Our patients enjoy the ability to resume all normal activities including recreational sports.

Anterior instrumentation and arthrodesis

With certain types of curves, the correction and spinal fusion is best done anteriorly — from the front of the patient. Recently, the use of anterior spinal correction has been indicated for some thoracic curves, particularly those that are stiff or those with poor spinal balance.

We usually suggest an anterior rather than a posterior approach if the curves that need correction are located in the lower spine (thoraco-lumbar and some lumbar curves). The advantage of anterior surgery is that with a complete discectomy (disc removal), stabilizing the spine with metal rods and performing fusion become a highly successful way of correcting the child's deformity. The combined procedures help achieve an excellent correction and good frontal balance with a shorter segment of the spine than is possible with the standard posterior approach. A shorter segment means flexibility can be preserved.

In this procedure, your child will be fully anesthetized in our state-of-the-art operating rooms. The front of the spine is approached from the side (see Figure 3), either through the chest, flank or both. This allows for complete removal of the intervertebral discs in order to provide greatly increased spinal flexibility and better correction of the scoliosis. Following this, screws are placed across the vertebrae (see Figure 4). A contoured rod can then be inserted into the screw heads and manipulated to make the correction. The spinal fusion is accomplished by inserting small fragments of bone graft (see Figure 5), sometimes with a cage implant, into the empty disc space.

Anterior spinal release

Larger curves that are still flexible can generally be treated with posterior instrumentation and spinal arthrodesis (fusion) alone (see above). When the deformity is rigid, however, it does not respond as well to this method of correction. That's when the best treatment may be an anterior spinal release. This alternative will help provide flexibility for your child, and an improved ability to correct the deformity.

In this procedure, your child will be fully anesthetized in our state-of-the-art operating rooms. Anterior release can be done as a conventional open surgical procedure or through an endoscope. The spine is approached from the front — through the side of the chest or flank. The intervertebral discs and restricting ligaments can be surgically released (cut), so that the stiffness of the deformity is relaxed. This allows improved correction and fusion (see Figure 6).

Thoracoplasty

An important part of the scoliosis deformity is the prominence or "rib hump." This appears as an elevation of the ribs, which can become very prominent and appear as a hump pointing backwards and away from the trunk. Often, from the child's or teenager's point of view, this is the most noticed and most cosmetically disturbing part of the scoliosis deformity.

With the larger and stiffer curves, correction of the scoliosis curve may not completely correct this rib hump. In these cases, we may suggest a thoracoplasty. This is done simultaneously with the spinal correction, therefore adding little inconvenience to the patient. In this procedure, your child will be fully anesthetized in our state-of-the-art operating rooms. Then the deformed ribs are cut, which allows them to be reshaped.

Contact us for more information on these or other types of scoliosis surgery.

Neurophysiological spinal cord monitoring at The Children's Hospital of Philadelphia

The major complication of spinal surgery to correct deformities is spinal cord injury, which can lead to weakness or even paralysis. Although this is a rare occurrence (one in 500 cases in North America), all efforts must be taken to avoid it. Our first goal for surgical treatment for spinal deformity is to provide safe correction and to avoid complications. That's why we believe it is absolutely necessary to monitor function of the spinal cord during surgery.

This can be provided with the still valid, traditional technique for spinal cord monitoring, which involves intermittently waking the patient during surgery and commanding him or her to move the legs so that motor function can be evaluated. However, because this "wake-up test" cannot provide real time information about the health of the spinal cord, we have chosen to use neurophysiological monitoring as our principle method for observing spinal cord integrity. With neurophysiological monitoring, both the motor and sensory tracts of the spinal cord can be observed at the same time.

To the neurophysiologist, the spinal cord and peripheral nerves are similar to cables, though which communication signals are transmitted and received. When monitored, these signals are observed with virtually no lag time, making the information available in current "real time." As a result, the neurophysiologist can instantly detect any adverse change in spinal cord function and alert the surgeon to take appropriate action.