Early Onset Scoliosis Surgery
When is this procedure indicated?
Surgery to correct Early Onset Scoliosis is generally indicated in presence of a primary curve greater than a Cobb angle of 40° or in case of rapidly progressive curves which are not responsive to the conservative treatment . The procedure is also indicated in presence of a reduced respiratory capacity or alterations of lung function.
How is it performed?
The surgical procedures are performed under general anaesthesia, in prone position, with spinal cord monitoring of somatosensory and motor evoked potentials. A dedicated instrumentation is used to provide the correction of the deformity. The implants positioning may be performed, free hand, under fluoscopic giudance or in specific case under CT guidance. Finally bone grafts, augmented by biologic or synthetic bone per surgeon preference, are placed in a specific area of the spine in order to obtain there a solid fusion. For the anterior approaches the procedure requires general anaesthesia and it is performed in laterl position with a mini-invasive approach to the spine. Also in these cases spinal cord monitoring and PESS and PEM are highly recommended.
After scoliosis surgery, patients are in most cases transferred to a surgical intensive care unit or surgical step-down unit. Pain management consists of long-acting intravenous pain medication. Surgical drains are placed and remain until 24 hours post-surgery. Patients are expected to ambulate on postoperative day 1 or 2 at surgeon preference, with or without a post-operative brace. Patients are able to come back home in 5-7 days and to school after 2-4 weeks. For about 4 months sport and strong phisical activity are discouraged. In specific cases a postoperative rehabilitation period (7-20 days) is reccomended. The TGR techniques need multiple re-operations to follow the growth of the spine (every 6-8 months): this negative aspect is partially reduced with other techniques such as Magnetically controlled Growing Rods or Guided Growth Implants. Usually at the end of puberty the final spinal fusion is recommended.
The most fearful short-term complications after surgical treatment of scoliosis are neurological ones, ranging from the temporary loss of skin sensitivity, to weakness or loss of strength in the feet or legs, up to paralysis. Other possible complications are postoperative anemia that sometimes needs blood transfusion, persistent postoperative pain, superficial or deep infections, skin breakthrough. Pulmonary, intestinal or thromboembolism complications may rarely occur. The underlying etiology of the secondary scoliosis may increase the risk of complications
In some cases, there is an increased incidence of back pain, loss of flexibility with limited range of motion, and loss of strength in the muscles surrounding the spine. Possible long-term complications may involve the instrumentation used for fixation, for its breakage or loosening, or for a late deep infection.