Spinal deformity is the loss of the normal spinal alignment. Scoliosis (abnormal sideward bending of the spine) and kyphosis (abnormal forward bending of the spine) are the two common types of deformity. Some of these deformities can get worse and need surgical treatment.
Spinal deformities arise from a variety of causes. For most adolescents, the exact cause is not known. Other causes for a spinal deformity could occur by birth or as a manifestation of some other disease (e.g. neurofibromatosis, polio, cerebral palsy and Marfan syndrome). Spinal deformities are caused by degenerative conditions in adults, as well as previous spinal surgery or even persistent childhood deformities.
Treatment options for scoliosis and kyphosis
- Observation – Serial x-rays to assess progression
- Brace – Usually recommended during the growing stages in children and adolescents
- Surgery – Surgery is indicated when curve progression occurs or is anticipated, or to correct a cosmetic deformity that is unacceptable to the patient. In adults, pain relief and improving function may be additional considerations.
Surgical options for the correction of spinal deformities
There are a number of alternatives in spine deformity surgery
- Anterior surgery (from the front through the chest wall or abdomen) involves the removal of intervertebral discs and correction of the deformity using screws and rods and/or bone graft (taken from the pelvis).
- Posterior surgery (from the back) involves the removal of some of the joints of the spine and correction of the deformity using screws, hooks and rods and supplemented with bone graft (taken from the pelvis).
Occasionally, a combination of an anterior and posterior surgery may be necessary. This can be done on the same day or separately.
In the recovery room: After the surgery, you may feel some pain on the operated area when you wake up. Pain medications, antibiotics, and IV fluids will help you stay hydrated and stable. You may also receive a temporary urinary catheter to use the bathroom. Additionally, a neck collar will help keep you comfortable and secure.
In the ward: After your surgery, you’ll be on a liquid diet before slowly going back to a full, regular diet. The drain tube and catheter will be removed. You’ll be able to walk around. Typically, you’ll stay in the hospital for 1-3 days, depending on your surgeon’s suggestions.
At home: Remember to stay active to speed up your recovery! Take short walks every day and slowly increase the distance. Please avoid heavy lifting, strenuous activity, and excessive movement of your neck. If you can, try to have someone to help you with your chores and errands for the first few weeks. The last thing you want to do is over-exert yourself! Children and teenagers may return to school/college after six weeks. Be advised that contact sports are NOT recommended for the first six months.
Risks and potential complications
All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. Allergic reaction to the anaesthetic or other medications and unforeseen complications such as pneumonia, stroke or heart attack are not caused by the surgical treatment and although rare, may have serious consequences. Please let your surgeon and anaesthetist know if you are allergic to medications and if you have any medical problems (relating to your heart, lungs, diabetes or increased blood pressure) and provide a list of your current and past medications.
The surgical complications include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, or injury to the nerve tissue or its surrounding protective layer. Injury to the nerves may occur during surgery, resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.
Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.
Deep vein thrombosis (DVT – blood clotting in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are uncommon after an elective spine surgery particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs, although we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.
The insertion of the screws can potentially cause nerve injury, resulting in weakness and abnormal sensations in the legs. Great care is taken to ensure the accurate placement of the screws, including the use of intra-operative fluoroscopy (x-rays). Correction of the deformity can also cause stretching of the nerves and spinal cord and may result in nerve injuries.
Another potential risk is that the fusion may not become solid, resulting in non-union, or pseudarthrosis. This may occasionally require a repeat surgery after a few months to supplement the bone graft to obtain a solid bony fusion.
Notify your surgeon at once if you notice the following after surgery
- Excessive bleeding
- Redness or discharge from the wound
- Persistent headache
- Weakness or numbness in the arms and legs
- Difficulty in passing urine
Talk to your surgeon
This is a brief overview and does not contain all the known facts about your condition and the treatment options. Feel free to seek any clarifications from your surgeon and his team. It is important for you to obtain a clear understanding of your condition and the risks, benefits and limitations of the surgical procedure before proceeding.