Adolescent idiopathic scoliosis surgery
What is it?
Posterior approaches with pedicle screws, hooks, sublaminar bands and rods fixation techniques represent the mainstay for AIS surgical treatment. Anterior approaches are usually reserved for severe deformities. In some cases it is possible to avoid performing an arthrodesis and apply a technique of motion preservation surgery (Vertebral body tethering).
When is this procedure indicated?
Surgery to correct adolescent idiopathic scoliosis is generally indicate in presence of a primary curve greater than a Cobb angle of 40° or in case of rapidly progressive curves (more than 10 degrees in six months). The procedure is also indicated in presence of a reduced respiratory capacity or alterations of lung function.
How is it performed?
The most commonly adopted surgical approach is posterior spinal fusion. 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 correction, with translation and derotation techniques, and to stabilize the obtained correction. An intraopeartive radiographic control is taken during screws insertion, after that two rods were inserted to perform correction and stabilitation maneouvers. Finally bone grafts, augmented by biologic or synthetic bone per surgeon preference, are placed in order to obtain a solid fusion and mantain correction over time.
Recovery
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 48 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 7 days and to school after 2-4 weeks. For about 4 months sport and strong phisical activity are forbidden.
Short-term complications
The most fearful short-term complications after surgical treatment of scoliosis are neurological ones, accounting for about 1-2 % of cases, 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. Pulmonary, intestinal or thromboembolism complications may rarely occur.
Long-term complications
Usually adolescents who have undergone spinal fusion for scoliosis are able to lead a normal life in the future with few limitations. A complete recovery and return to normal daily life is possible after 6-12 months from the operation. 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.
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