What is a spinal osteotomy?
A spinal osteotomy is a surgical procedure used to correct deformities in the spine. Here, bone is removed from the back of the vertebral arch to correct long, gradual curves of kyphosis like those produced by Scheuermann’s kyphosis or ankylosing spondylitis.
The majority of procedures that treat spinal deformities are types of osteotomy. These include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR).
When is a spinal osteotomy performed?
Proper spinal alignment is important for pain-free functioning of the spine. The slight lordosis of the neck and lumbar (lower) spine are balanced by a slight kyphosis of the thoracic (upper) spine. These curves work in harmony to keep the body’s centre of gravity aligned over the pelvis.
A reduction in lordosis in the lower region of the spine (also known as flatback syndrome) or an excess in kyphosis in the upper region of the spine (known as hyperkyphosis) results in spinal misalignment. This is called sagittal imbalance and can cause fatigue, pain and compression of organs such as the heart and lungs.
During a spinal osteotomy, the surgeon removes a wedge-shaped section of bone from the back of the spine. Closing this wedge either adds lordosis or reduces kyphosis. This disc in front of the removed bone must accommodate the new position of the bones, so a spinal osteotomy requires a flexible disc between the target vertebrae. A surgeon assesses spinal flexibility during the creation of a treatment plan. If the discs cannot support a spinal osteotomy, other surgical options may be considered instead.
A PCO usually provides a patient with 10-20 degrees of correction, but this procedure is often performed at multiple spinal levels. Depending on where and how much correction is needed, a series of PCOs can ‘add up’ to the desired correction.
How is a spinal osteotomy performed?
A spinal osteotomy is conducted under general anaesthetic, meaning the patient is unconscious. They are placed face-down on the operating table, where the surgeon makes an incision over the spine to expose the bones in the spinal column. The surgeon then places screws into the vertebrae above and below the area from which the bone is to be removed. The heads of the screws are designed to hold rods. At the end of the surgery, the surgeon will insert rods that immobilise the spine while it heals in its new position.
Next, the surgeon removes bony projections that extend from the back of the vertebrae. The surgeon then removes sections of bone called the lamina at the back of the vertebrae and portions of facet joints between the vertebrae that will be realigned.
It is then time to realign the vertebrae. Here, the surgeon manipulates the patient’s spine into a new position, using implants to obtain the desired correction. Once alignment has been achieved, the surgeon inserts rods into the screws that were placed at the beginning of the surgery. The role of the rods is to hold the bones of the spine in the position achieved during the surgery while they heal. After this, the surgeon will apply bone graft or transplanted bone over the vertebrae. The bone graft will fuse with the vertebrae, forming one solid bone. Achieving good bone fusion is vital for long-term stability.
What to expect after a spinal osteotomy
Once the spinal osteotomy procedure has been successfully completed, you may have a number of questions. Let’s answer several common post-osteotomy questions right now:
How long will I have to stay in the hospital?
Patients typically stay in the hospital for 5-7 days after their spinal osteotomy procedure.
Will I need to wear a brace or collar?
Sometimes surgeons may prescribe a brace or collar if the osteotomy was performed in the neck. If performed on the spine, this is less common.
Will I have to take any medication?
If any discomfort is experienced after the spinal osteotomy, pain relief medication may be prescribed.
How long before I can exercise again?
You can begin to walk as soon as you’re comfortable to do so. More rigorous forms of exercise will have to wait until later on in the healing process.
Will I require any form of rehab or physical therapy?
Yes, physical therapy will be a part of your recovery process.
Will spinal osteotomy cause any long-term limitations?
As a result of your fusion, you may experience some decreased mobility; however, this all depends on your particular procedure.
How can Scoliosis SOS help?
If you have undergone a spinal osteotomy procedure and your doctor recommends participating in physical therapy as part of your recovery plan, we at the Scoliosis SOS Clinic can help!
We offer world-renowned physical therapy that helps to increase the spine’s range of motion and strengthen the muscles in your back, helping you to resume regular activities as soon as possible. Our ScolioGold method combines the well-known Schroth method with other proven therapy techniques to help speed up your spinal osteotomy recovery.
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Earlier this week, Channel 4 aired a documentary called Save My Child. It focused on two young people with lifelong health conditions and their families’ efforts to raise the funds for private treatment.
One of the children featured was Mia, a 15-year-old girl with scoliosis. Here’s a clip from the programme:
Mia’s curved spine, along with the scoliosis brace that she had to wear for 23 hours a day, meant that she was in near-constant pain. At the start of Save My Child, we see Mia lying awake at night and struggling with everyday tasks like tying her shoelaces.
Frustrated with the long waiting lists for spinal fusion surgery – and fearing that Mia’s condition would only get worse with time – her family started researching alternatives. Eventually, they decided to travel to Turkey so that Mia could undergo vertebral body tethering (VBT) surgery.
The Channel 4 programme primarily focused on how Mia’s family managed to raise tens of thousands of pounds to pay for private surgery. What it didn’t do was take a critical look at the VBT procedure itself and how effective it actually is.
Is VBT a good alternative to spinal fusion surgery?
First of all, it’s important to note that VBT is a rather controversial topic here in the UK. It was the subject of much discussion at the recent British Scoliosis Society conference in Cardiff – many British families go abroad for VBT, with Germany and Turkey the most popular destinations, but in many cases there are no formal standards in place for this procedure. And if complications occur back home, the NHS must then pick up the cost of fixing an operation that was paid for privately in a different country!
Fortunately, the outcome for Mia was a positive one (“I’m a lot happier now,” she told Channel 4), but here at the Scoliosis SOS Clinic, we’ve met a number of scoliosis patients who weren’t so lucky. One family came to see us after their daughter had undergone the VBT procedure in Turkey – they were concerned that she didn’t look any different, and in the end they signed her up for a ScolioGold treatment course, an option they had previously passed up in favour of the VBT route.
Potential complications of VBT
If you need another reason to think twice before going abroad for VBT surgery, we have met multiple scoliosis patients who ended up suffering from pleurisy after the procedure. This is a sharp pain in the chest that occurs when you take a deep breath.
Still other patients found that the tethering had been done on the wrong side of the spine, making their scoliosis worse and creating nerve complications.
Finally, it should be noted that the death rate for VBT is 3%. This is significantly higher than spinal fusion surgery.
A safer alternative to spinal fusion
While vertebral body tethering may become a more viable option in the future, there simply isn’t enough evidence of its effectiveness just yet (this is the main reason why VBT isn’t currently available on the NHS).
The Scoliosis SOS Clinic’s physiotherapy-based scoliosis treatment courses offer a non-invasive, low-risk alternative to scoliosis surgery. We have helped patients of all ages to manage their severe spinal curves and live happier, more active lives. On many occasions, our treatment programme has reduced the angle of the patient’s curvature to a point where they’re no longer a candidate for surgery at all!
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Last night (10 April 2019), 18-year-old Chloe Donhou from Essex underwent spinal fusion surgery to correct her 60+ degree scoliosis. This wouldn’t normally be headline news – scoliosis affects approximately 3% of the population, and countless spinal fusion procedures are carried out worldwide each year – but Chloe’s operation was noteworthy because it was televised.
Channel 5’s Operation Live is a groundbreaking television series that’s exactly what its title suggests: live TV broadcasts of surgical operations, interspersed with commentary from the medical professionals involved. At the centre of last night’s instalment was Chloe, who has spent much of the last 18 years in pain as a result of her spinal curvature.
Speaking to the Express ahead of her operation, Chloe said: “This is something I’ve been waiting for my whole life. It’s finally happened. It’s the little things people don’t understand…if I go bowling with friends, I’ll be in agony the next day.”
Chloe’s spinal fusion procedure was carried out by the orthopaedic team at The Royal London Hospital, and watched by viewers all over the UK.
Read some of the reactions to Chloe’s spinal fusion surgery on Twitter >
Is spinal fusion surgery the only answer for people with scoliosis?
Here at the Scoliosis SOS Clinic, we provide exercise-based physical therapy that helps people with scoliosis to live better lives. We quite frequently hear from individuals who are looking for alternatives to spinal fusion surgery – as effective as the operation is, there’s always a risk associated with any surgical procedure, and many scoliosis patients prefer not to go through with it.
Over the last 12-13 years, we have helped many people with scoliosis to improve their condition and avoid spinal fusion surgery. Our internationally-renowned ScolioGold treatment method has proven capable of:
- Reducing pain
- Making spinal curves smaller
- Improving muscle balance and flexibility
- Boosting overall quality of life
If you would like to find out more about the Scoliosis SOS Clinic and the treatment we provide, please telephone 0207 488 4428 or fill out our online enquiry form.
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If you suffer from scoliosis, you will probably have looked into the various treatment options for this condition. Today, we’re going to look at the pros and cons of one specific treatment method: spinal fusion surgery using Harrington rods.
What are Harrington rods?
Developed in the early 1960s by Dr Paul Harrington, the Harrington rod is a straight rod that contains a ratcheting mechanism. These rods are used in spinal fusion surgery to reduce the curvature of the patient’s spine.
The rod is positioned along the concavity (inside) of the spinal curve and attached to the spine using two hooks – one attached to a vertebra at the bottom of the curve and the other to a vertebra at top of the curve. Then, employing the ratcheting mechanism, the surgeon stretches the spine to straighten the curve and fuses into position.
Do Harrington rods help to correct scoliosis?
For 20 years, Harrington rods were seen at the ‘gold standard’ for spinal fusion surgery – if you underwent spinal fusion surgery before the year 2000, the surgeon most likely used Harrington rods. This procedure was routinely recommended for any patients with a spinal curve exceeding 45 degrees.
These days, however, there are a number of alternatives for scoliosis patients who require surgery. You can read about these more modern methods here.
Harrington rods have been successful in many cases of scoliosis, but they also come with a number of risks and limitations.
What are the risks and limitations of Harrington rods?
As with all surgical operations, there are risks involved with the procedure described above. This intrusive operation requires the surgeon to remove spinal discs and muscle so that the rod can be inserted and screwed onto the vertebrae. The spine is then bent forcefully and fused into that position. Infection is one possible complication – other potential risks include:
- Bending and breaking of the rod
- Hardware migration
- Pseudoarthrosis
- Flat back syndrome
Furthermore, this surgery is not recommended for patients whose spines are still growing. Performing a spinal fusion on a growing child can lead to a number of complications, such as the Crankshaft phenomenon. As young spines continue to grow there is a chance the spinal curve will also change, which may mean the rod will end up causing further complications.
What are the alternatives to surgery?
In some very severe cases, surgery is the only way to ensure that a spinal curve will not get any worse. In most cases, however, there are plenty of other scoliosis treatment methods available that do not involve intrusive, potentially risky surgical procedures.
Here at the Scoliosis SOS Clinic, we offer a non-surgical scoliosis treatment programme called ScolioGold therapy, which combines a number of effective techniques to improve patient’s condition. To see how effective non-surgical treatments can be, have a look at our results and see how we have reduced our patients’ Cobb angles without surgical intervention.
If you have any more questions about scoliosis surgery and how our non-surgical approach can help you with your back condition, please get in touch today.
