January 2, 2018

New Scoliosis Surgery Techniques: Alternatives to Spinal Fusion

erika Scoliosis & Other Back Problems
Surgery is often recommended once a scoliosis patient’s spinal curve has progressed beyond a certain point, and in the vast majority of cases, ‘surgery’ means spinal fusion surgery. This procedure involves joining two or more vertebrae together to prevent the patient’s curvature from growing; nowadays, this is usually achieved by fastening small metal screws called pedicle screws to the spine, then using a bone graft to ‘fuse’ the vertebrae together However, while this procedure is still the standard surgical scoliosis treatment method in most parts of the world, there are a number of risks associated with spinal fusion. Though rare, the potential complications include:
  • Screws placed in the wrong positions
  • Screws breaking or coming loose
  • Dural lesion
  • Infection
  • Various neurological, pulmonary, and vascular complications
In response to the risks sometimes associated with spinal fusion, a number of other surgical scoliosis treatments have been developed, and some of these new techniques seem to becoming increasingly popular. Today, we’d like to look at three relatively new surgical procedures and why they’re potentially preferable to spinal fusion surgery.

Magnetically-controlled growing rods (MCGR)

Magnetically Controlled Growing Rods

Magnetically-controlled growing rods are already being used in more than 20 countries (including the UK and the USA) to treat scoliosis in children under the age of seven. During the MCGR procedure, the surgeon fastens titanium rods to the patient’s spine; these rods have a lengthening mechanism that can be operated magnetically, and after the operation itself, the patient attends a series of minimally-invasive ‘distraction’ procedures where a remote controller is used to lengthen the rods and correct the spinal curvature. This effectively puts the doctor in control of the child’s scoliosis until they have finished growing.

 

Stapling and tethering

Spinal Tethering Operation

Vertebral body stapling (VBS) and vertebral body tethering (VBT) are two minimally-invasive procedures that are usually performed on scoliosis patients who are still growing (e.g. teenagers and pre-teens). VBS uses malleable metal staples to join two or more vertebrae together, while VBT uses pedicle screws attached to a flexible cable at the site of the curvature. VBS is recommended for thoracic curves of 25-35 degrees and lumbar curves under 45 degrees; VBT can be used to treat thoracic curves between 35-70 degrees. Currently available only in the UK, the USA, India, Canada and New Zealand, the tethering and stapling procedures have no major reported complications and are generally less invasive than the more commonly-seen spinal fusion procedure.

Apifix

Apifix for Scoliosis

Apifix is a small implant that is attached to the spine using just two screws. No fusion is performed, and the procedure is not very invasive, leaving a far less visible scar than spinal fusion surgery.

Apifix Scar

This procedure is ideal for adolescents with idiopathic scoliosis, especially where the curve measures 40-60 degrees. Apifix is currently available in the USA, Israel, and across Europe. Any surgery carries risks and complications, depending on the procedure and patient presentation. If you are looking for a non-surgical alternative to spinal fusion, please contact the Scoliosis SOS Clinic today. We use an exercise-based regime called ScolioGold to correct scoliosis without any surgical intervention whatsoever. We can also assist with recovery after undergoing scoliosis surgery.
November 27, 2017

Scoliosis Surgery: More FAQs

erika Scoliosis & Other Back Problems

Scoliosis Surgery

Earlier this year, we answered some frequently asked questions about scoliosis surgery to provide you with more information on the spinal fusion procedure that is often used to correct severe spinal curves. Since then, we’ve been asked a number of other questions about this operation, so we thought we’d assemble another list of frequently asked questions to give you a little more insight into what scoliosis surgery is really like.

Q. Does scoliosis surgery hurt?

A. You won’t experience any pain during the surgery because you’ll be under general anaesthesia, but you may experience some discomfort after the operation. While you recover, you will be given PCA (patient-controlled analgesia) – a pump that delivers morphine or other painkillers into your system when you press a button. This will control the pain for the first few days after surgery. Most patients are moved off PCA after 2-3 days and then begin a course of oral pain medication. When discharged from hospital, a prescription for pain medication is provided. In most cases, children are usually off medication within two weeks; however, adults may require medication at diminishing doses for weeks or even months after surgery.

Q. Does scoliosis surgery leave a scar?

A. Yes, you will be left with a scar but it will gradually fade over time. The length of the scar depends, at least in part, on how many curves there are in your spine. If you have just one spinal curve, your scar should be roughly 10 inches long. However, if you have two or more curves in your spine, your scar may begin in the middle of your shoulder blades, and may finish as far down as your pelvis. Surgeons will try to keep the scar as thin as possible by placing the sutures beneath the skin. Some surgeons may even use a special type of glue that promotes wound healing.

Q. Does scoliosis surgery make you taller?

A. Yes – but the length of your spine will not have changed. The increase in height is due to your spine being straightened and therefore appearing longer. The increase in height depends on the severity of your spinal curve.

Q. What kind of doctor performs scoliosis surgery?

A. Both orthopaedic surgeons and neurosurgeons can carry out a spinal fusion procedure. Scoliosis surgery was originally carried out exclusively by neurosurgeons, but nowadays, orthopaedic surgeons are equally well-qualified to undertake the majority of spinal operations.

Q. How long does scoliosis surgery take?

A. The spinal fusion procedure tends to take 4-6 hours, but the time can vary between patients. The surgeon will take as long as necessary to ensure the patient receives the best results.

Q. Can you exercise after scoliosis surgery?

A. Yes – in fact, exercise helps with the rehabilitation process. Physical therapy is encouraged as it stretches and strengthens the muscles around the spine, and also improves neuromuscular stability. However, it is recommended that you don’t do anything too strenuous, as it could worsen your condition.

Further reading:

Scoliosis SOS is a UK-based clinic providing non-surgical treatment for scoliosis and other curvatures of the spine. Click here to learn about our treatment methods, or get in touch to arrange an initial consultation.
November 22, 2017

What are Magnetic Growth Rods?

erika Scoliosis & Other Back Problems

Magnetic Growth Rods

Spinal fusion is the most commonly-used surgical treatment for scoliosis, but there are other procedures that can be used to combat a curvature of the spine. The use of magnetic growth rods is becoming more widespread – but exactly what does this procedure entail?

What are magnetic growth rods?

The magnetic growth rods procedure is relatively new, and it has been developed to improve the traditional growing rod procedures. Usually recommended only for young patients, the procedure is performed in an outpatient clinic under the control of an externally-applied magnet control device. It has shown itself to be a relatively safe and effective procedure, and only requires a short-term follow-up. Magnetic growth rods aim to control the patient’s spinal curve during the growth and development stage, until the patient nears skeletal maturity (after 11-13 years of age). The procedure itself consists of single or dual titanium spinal rods that contain a magnetically drivable lengthening mechanism. These rods are inserted at the two most cranial levels and the two most caudal vertebral levels for distal fusion segments. Pedicle screws are used as anchors before passing the rods subcutaneous/submuscular to connect to each fusion segment. Patients are required to undergo a post-op procedure (distraction) after the initial surgery is complete.

What happens during the post-op procedure?

The post-op procedure is not very invasive, and patients are required to undergo follow-ups for 6 weeks for distraction. An external remote controller is placed over the internal magnet, and once applied, the rotating mechanism causes the rods to lengthen, thus distracting the spine. During each distraction visit, the aim is to lengthen the spine by 1.5 to 2mm. If the patient is experiencing any pain or discomfort, the device can retract. The procedure is pretty quick, and tends to last around 30 secs to a minute. This procedure is usually performed on children under the age of 7 that have been diagnosed with early onset scoliosis.

What complications can arise?

There are fewer complications associated with magnetic growth rods than with other scoliosis surgeries, but that doesn’t mean there aren’t any risks involved. There is a small chance that the rod may break and cause some damage to your spinal cord. There is also a risk that the pedicle screws may come loose and pull out, and on rare occasions, the device may also fail to construct a distraction. MAGEC rods are expected to last for approximately 24 to 36 months before they have to be replaced, at which point you will have to undergo surgery again.

How can we help?

If you don’t want your child to undergo this type of scoliosis surgery, or if you’re looking for something to help with the rehab process, the Scoliosis SOS Clinic can help! We treat all of our patients non-surgically, treating their conditions using an exercise-based treatment method that provides unrivalled treatment success. Please feel free to contact us to find out more about our unique treatment method, or to book an initial consultation.
November 13, 2017

Spinal Tethering & Stapling for Scoliosis

erika Scoliosis & Other Back Problems

Spinal Tethering & Stapling

Many of the patients we treat here at the Scoliosis SOS Clinic come to us in search of an alternative to scoliosis surgery, but while our ScolioGold method has consistently proven capable of reducing spinal curvature and improving quality of life (thus eliminating the need for surgical intervention), our exercise-based therapy has on occasion been used in conjunction with surgical treatment when the case called for it. The most common form of scoliosis surgery is spinal fusion, but there are a number of other techniques in use, and some of these have seen a boost in prominence and popularity of late. One approach that you might have heard of is spinal tethering, which comes in two different varieties: vertebral body stapling and vertebral body tethering.  

What is vertebral body stapling?

Vertebral body stapling (VBS) is a less invasive alternative to spinal fusion surgery. This procedure aims to control the progression of the patient’s spinal curvature through the use of special metal staples, which are attached to the vertebrae in the curved part of the spine. This creates a sort of internal scoliosis brace – the staples restrain one side of the spine while allowing the other side to grow normally, thereby countering the progression of the curvature. VBS may be used to treat a thoracic spinal curve measuring 25-35 degrees, or a lumbar curve of under 45 degrees.  

What is vertebral body tethering?

Vertebral body tethering (VBT) uses pedicle screws instead of malleable metal staples. These screws are inserted into the affected vertebrae and attached (tethered) to a flexible cable at the point where the spine curves. This procedure was developed with larger spinal curves in mind. VBT is used in cases of scoliosis where the curve measures 35-70 degrees.  

Benefits of spinal tethering

Both VBS and VBT are preferable to spinal fusion surgery in a number of ways – most importantly:
  • These procedures are less invasive than spinal fusion
  • Spinal fusion is generally only available to scoliosis sufferers who have reached maturity and finished growing; VBS and VBT, by contrast, are recommended for young patients who are still growing
 

Is spinal tethering effective?

On occasion, a scoliosis sufferer will come to the Scoliosis SOS Clinic in order to improve their flexibility and spinal correction ability before undergoing spinal tethering surgery. Then, after their VBT/VBS procedure, that individual will return to us as a post-surgery patient on a modified programme that’s designed to aid with scar tissue management and general rehabilitation. Our treatment programme also helps to prevent future progression of the patient’s condition. We have treated a number of post-VBT/VBS patients this way, and in our experience, spinal tethering/stapling has no positive impact on spinal rotation. This means that cosmetic changes to the patient’s rib cage are minimal, so be sure to take this into consideration when weighing up your scoliosis treatment options. It’s also worth noting that VBT/VBS are not currently available in the UK due to a lack of research. At time of writing, these procedures are only being carried out in the USA, Canada, New Zealand and India, and many scoliosis patients have had to pay hundreds of thousands of pounds to undergo spinal tethering abroad. Interested in non-surgical scoliosis treatment? Contact Scoliosis SOS today to arrange a consultation.
June 27, 2017

Spinal Fusion Surgery: Success Rate & Other Information

erika Scoliosis & Other Back Problems
Spinal Fusion Surgery
 
Spinal fusion is a surgical procedure that is commonly recommended in severe cases of scoliosis. In the UK, spinal fusion surgery will usually be considered as a treatment option once the patient’s spinal curve measures 40 degrees; in some other countries, it may not be recommended without a Cobb angle measurement of at least 50 degrees.
 
 

Does spinal fusion surgery have a high success rate?

There are lots of stories on the Internet about spinal fusion procedures that didn’t have the desired effect (i.e. reducing curvature, preventing further progression of the curve, and easing symptoms such as back pain). There are even some accounts of operations that made things worse, leaving the patient in more pain and even less able to move around freely.
 
It is true that spinal fusion surgery can go wrong, but in the majority of cases, there are no significant complications and the treatment works well. As Leah Stoltz, founder of the Curvy Girls support group for young scoliosis sufferers, told us when we interviewed her:
 
“Something I’ve noticed a lot is that you really only hear scary or worrisome stories of surgeries not going well. For the innumerable number of cases that go well, they don’t necessarily need to talk about it as much…that’s one of the reasons I try to talk about [my experience of spinal fusion surgery] so much.”
 
According to the University of Washington’s Department of Orthopaedics & Sports Medicine, the average curve correction achieved when spinal fusion is carried out on someone under 16 with idiopathic scoliosis is roughly 70%. The operation carries a 2-3% risk of complications.
 

What complications can arise?

When complications do arise from spinal fusion surgery, they vary greatly in severity and seriousness. Possible complications include:
  • Infection
  • Failed fusion
  • Paralysis
However, as stated above, the risk of complication – especially severe complication – is very low.
 

Alternatives to spinal fusion surgery

If your scoliosis has progressed to the point where you are being considered for surgery, you have probably already tried other treatment methods such as bracing. However, even advanced cases of scoliosis (40-50 degrees and over) may be treated via a non-surgical, exercise-based programme such as ScolioGold.
 
ScolioGold
 
Here at the Scoliosis SOS Clinic, we have treated countless scoliosis patients who thought that surgery was their only remaining option. The ScolioGold method, our own carefully-selected combination of non-surgical treatment techniques, has proven very effective in relieving pain, reducing curvature, improving mobility and muscle balance, and improving overall quality of life.
 

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