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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Friday 25 October 2019 is World Spina Bifida and Hydrocephalus Day. This year also marks the milestone 40th anniversary of the International Federation for Spina Bifida and Hydrocephalus.
What is Spina Bifida?
To mark this occasion, we’d like to share the story of Samantha Joyce, a Scoliosis SOS patient who has spina bifida as well as scoliosis.
Patient Story: Samantha from Sidcup
Samantha is a woman from Sidcup, Greater London who got in touch with the Scoliosis SOS Clinic after our recent appearance on BBC One. She was diagnosed with scoliosis at 11 years old; she also has spina bifida and hydrocephalus.
Samantha was prescribed a scoliosis brace, and when she was 13, surgeons placed screws in her spine in order to correct her spinal curve. Unfortunately, this operation did not have the desired effect – after a long and arduous recovery process, Samantha had to have the screws removed at the age of 18 because they had caused an abscess and she had lost the use of her left leg!
Samantha is now in her 40s, and she was still experiencing back pain as a result of her scoliosis and her spina bifida. She came to the Scoliosis SOS Clinic in the hope that our therapists would be able to help her – watch the video below to find out how she got on.
Feedback from Samantha
“Thank you all so very much for all you have done. I’m so glad I found out about this clinic and had the opportunity to experience the wonderful work you do.
“It’s amazing how I have changed since I started: pain-free, more definition in my legs, and my whole body feels freer. A friend said, without prompting, how much straighter I was sitting, and I’m able to sit and stand for longer without any pain.
“I have now been discharged from King’s College Hospital after a year and a half. Thank you for being a valued part of my recovery, and keep up the fantastic work you do – it’s invaluable!”
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The most important thing to keep in mind when seeking information on your
curved spine is the fact that no two curves are the same. In fact, even perfectly healthy spines have some level of curvature, although this slight curve does not pose a problem unless it grows to be abnormally severe. Curvatures can occur in different parts of the spine and develop into a variety of shapes depending on the direction and location of the irregularity.
Previously on the Scoliosis SOS blog, we discussed the characteristics of
hyperkyphosis, a spinal condition which causes the
upper region of the spine to curve forwards, creating a hunched appearance. Hyperlordosis, on the other hand, occurs in the
lower (lumbar) spine, causing the patient to have an excessively arched posture in the lower part of the back.
To explain in more detail, here’s a closer look at the causes and symptoms of hyperlordosis.
What causes hyperlordosis?
The first thing to note about hyperlordosis is that it can impact people of all genders and ages – although it is rare in children. The condition is frequently caused by bad posture, along with a number of other contributing factors and conditions, including:
- Obesity
- Spinal injury
- Sitting or standing for extended periods of time
- Uneven muscles, particularly a weak core
- Injuries and trauma gained while dancing
What does hyperlodosis look like?
Hyperlordosis causes the inward curve in the lower back to become exaggerated, causing the stomach and bottom to appear pushed out, and the inward curve to resemble the letter ‘C’ when viewed from the side. To find out how this differs from the appearance of scoliosis and hyperkyphosis,
read our guide to different curvatures of the spine here.
Can hyperlordosis be treated?
In the majority of cases, hyperlordosis is not a sign of a more severe condition, meaning that it can be treated and managed with physical therapy and exercises designed to strengthen the back, correct the curve, and improve overall posture. Here at Scoliosis SOS, we are able to provide tailored treatment programmes that are specifically designed with the individual needs of our patients in mind, allowing us to provide the best possible treatment.
If you have recently been diagnosed with hyperlordosis and you would like to find out more about our non-invasive treatment methods, please feel free to contact the Scoliosis SOS team today.
The human spine (also known as the backbone or, more properly, the vertebral column) is made up of numerous small bones called vertebrae. When a vertebra is damaged or displaced, the knock-on effects can have serious consequences for the health of the entire back and even of the body as a whole.
One good example of this is a condition called spondylolisthesis.
What is spondylolisthesis?
Spondylolisthesis occurs when a vertebra slips out of place so that it is no longer aligned with the rest of the spine. This can happen for a number of reasons: some people are born with defects that lead to spondylolisthesis, but it can also be caused by a blow to the spine, a tumour, and the body’s natural ageing process, among other things.
Spondylolisthesis usually occurs in the lower (lumbar) spine, although it can happen further up too.
So, spondylolisthesis is the same as a slipped disc?
No. The phrase ‘slipped disc’ is perhaps a little misleading – it really has nothing to with vertebrae slipping out of place. Rather, a slipped disc occurs when one of the ‘discs’ that sit in between your vertebrae becomes ruptured. If this happens, the nucleus pulposus (a gel-like substance inside each disc) may bulge out through the wall of the disc, putting pressure on your nerves and resulting in pain.
This phenomenon is unrelated to spondylolisthesis, which affects the vertebrae rather than the discs that separate them.
Spondylolisthesis symptoms
Spondylolisthesis sufferers may notice some or all of the following symptoms:
- Back pain and/or stiffness
- Tightness of the leg muscles
- Sciatica (pain or discomfort of the legs and/or buttocks)
- Curvature of the spine (see below)
That being said, some people with spondylolisthesis don’t notice any symptoms at all.
Spondylolisthesis and scoliosis – what’s the connection?
As noted above, one possible outcome of spondylolisthesis is a curve in one’s spine.
Scoliosis (a sideways curve) or
hyperkyphosis (a forward curve) may develop due to the weakening of the backbone that occurs when a vertebrae moves out of place.
Scoliosis and hyperkyphosis can themselves lead to a number of health issues, including:
- Back pain
- Reduced mobility and/or flexibility
- Compromised breathing
A curved spine can also have visible effects (e.g. uneven shoulders, prominent ribcage), which in turn may result in reduced self-esteem and a negative body image.
Treating scoliosis and spondylolisthesis
Whether your spine is curved as a result of spondylolisthesis or another underlying condition, the Scoliosis SOS Clinic in London can help you. Our exercise-based
ScolioGold treatment programme has been fine-tuned to specifically address the needs of scoliosis and hyperkyphosis sufferers, and the results we achieve are consistently outstanding.
We use a variety of physiotherapy methods to treat those suffering from spondylolisthesis, such as:
- Schroth Method
- Rigo-Schroth Method
- FITS Method
- PNF Technique
- SEAS Method
- Taping
Click here to read about all the different methods we use to treat our patients’ spinal conditions.
For more information about our treatment courses, or to book an initial session with one of our consultants, please contact us today.
