There is no more common orthopedic surgery than the surgery for correcting scoliosis. Anyone who has more than a 40-degree lateral (sideways) deviation of the normal curvature of the spine is likely to be offered corrective surgery. The spine, of course, is a 3-D organ, but imaging techniques tend to pick up left-right or lateral curvature of the spine better than medial, forward-backward curvature of the spine.
For as long as 5500 years, doctors have used non-surgical methods to treat scoliosis. The Hindu scripture the Bhagavata Purana tells the story of how Krishna straightened the back of Kubja by pushing down on her feet and pulling up on her chin, the same kind of traction that would be used today. Twenty-four hundred years ago Hippocrates described treatment for scoliosis with an elaborate traction table called a scamnum. In the Renaissance, a doctor named Ambroise Pare devised a brace for treating scoliosis. In the early 1800's, a French doctor named Jacques Mathieu Delpech founded a sanitarium for treating scoliosis patients with fresh air and exercise. When Delpech was murdered by one of his patients, another French doctor developed a surgical technique for treating scoliosis that he used, mostly unsucessfully, on 1349 patients. He was sued on the ground that he had promoted an "orthopedic illusion," and lost. After that, French and American doctors for the next 100 years preferred a plaster cast around the torso.
Fortunately, by the 1990's, surgical technique had greatly improved. There are not as many complications of scoliosis surgery as there used to be, but one problem has emerged as a result of technological progress.
- The most common long-term complication of spinal fusion surgery for scoliosis is a condition called pseudoarthrosis. Basically, pseudoarthrosis means the spinal fusion surgery didn't work. As a result, hardware may break, there can be pain that just won't go away, or the spinal curvature can keep on getting worse.
- Pseudoarthrosis is detected by an imaging method called computed tomography (CT). However, fewer and fewer hospitals have CT scanners as the technology is being replaced.
- As a result, broken hardware, continuing back pain, and increasing curvature of the spine require exploratory surgery to look at the spine to determine whether the problem is actually failed spinal fusion.
Does this mean it would be better not to have the surgery at all?
About 4 percent of spinal fusions simply don't "take" at all. When the spinal fusion requires penetrating the chest cavity, it takes on average about a year to recover normal pulmonary function. During that time, the recipient of the surgery is especially vulnerable to respiratory infections and pneumonia.
When spinal fusion is successful, it's not necessarily permanent. About 10 percent of people have to have a second operation with one year. Only about 25 percent have to have the surgery redone even as long as 15 years after the initial procedure, however, and for a few, a single spinal fusion is a lifetime fix. Not surprisingly, the fewer segments of the spine that are fused, the greater mobility for the patient.
If you have already had surgery, what can you do to avoid needing it again?
- Keep your weight down. Morbidly obese people are up to 9 times more likely to suffer psuedoarthrosis after surgery.
- If you had complicated surgery (taking six hours or more), be especially careful to follow your doctor's orders. The longer the surgery, the greater the risk of complications.
- Be on the alert for signs of infection. One of the more common complications of surgery for scoliosis is infection of the joints of the spine with acne bacteria. Acne bacteria are everywhere, but when they are introduced inside bone, they can cause arthritis-like degeneration. Up to 10 percent of surgical patients will have infections up to four years after infection; sometimes infections don't become obvious for as long as eight years after the operation.
Be aware that if your spine looks straight, your surgeon is going to call the operation a success, no matter how bad your feel. Don't be afraid to speak up when you have pain, and don't be afraid to get a second opinion if your insurance and financial resources permit.
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