Scoliosis Surgery Success Story

The picture to the right is Deborah with her husband, Retired Col. Jeffry Butter.

Walking taller

In December 2018, the Butters moved to DFW and Dr. Hostin performed a spinal fusion on Deborah’s T1 through S1 vertebrae—virtually her entire back from the bottom of her neck to the top of her sacrum. She was home by January 7.

Before surgery, Deborah had almost no strength in her left leg. By June 2019, she was nearly full strength and was able to go camping in Alaska with her daughter’s family. She said it was hard to convince people that just six months earlier she had been nearly immobile.

“I feel like a walking miracle,” Deborah said. “I’m three-and-a-half inches taller! I can sit in a straight-backed chair and stand in line at the grocery store. There were so many things wrong with me that I can’t remember them all! I can’t say enough good things about Dr. Hostin and Southwest Scoliosis and Spine Institute. I couldn’t be any more blessed.”

What is Scoliosis?

Scoliosis, a condition characterized by an abnormal lateral curvature of the spine, often occurs during adolescence but can also affect adults, particularly due to degenerative changes as they age. While many cases of scoliosis are asymptomatic or managed conservatively, some patients experience chronic, debilitating pain that significantly impacts their quality of life. When non-surgical treatments such as physical therapy, medications, and bracing prove ineffective, surgical intervention may be considered as a last resort to relieve pain, stabilize the spine, and improve spinal alignment.

This paper explores scoliosis surgery focused on pain relief, detailing surgical goals, procedure types, patient selection criteria, and outcomes.

Goals of Scoliosis Surgery

The primary goals of scoliosis surgery are to:

1. Relieve pain caused by the curvature and any associated nerve compression or muscular strain.
2. Stabilize the spine to prevent further curvature progression and associated pain.
3. Restore spinal alignment to as close to normal as possible to improve posture, mobility, and quality of life.

Surgical interventions for scoliosis primarily target two types of pain:

• Axial pain (pain originating from the spine itself), often due to degenerative changes or muscle strain.
• Radicular pain (pain radiating down the arms or legs), which may occur if spinal nerves are compressed due to the curvature.

Surgical Options for Scoliosis

1. Spinal Fusion Surgery

• Procedure Overview: Spinal fusion is the most common surgical procedure for scoliosis. The surgeon uses bone grafts, rods, screws, and plates to fuse two or more vertebrae, effectively “locking” the spine in place to prevent further curvature.
• Approaches:
  • Posterior Approach: Performed from the back, this approach is widely used in scoliosis cases and allows access to several vertebrae at once.
  • Anterior Approach: Performed from the front or side, this approach is sometimes used for thoracic curves.
• Fusion Levels: The number of levels fused depends on the curve’s severity and location. More extensive fusions are sometimes necessary to provide stability and pain relief but may limit mobility.
• Pain Relief: By stabilizing the vertebrae, fusion reduces motion at painful segments, thereby alleviating pain. Pain relief rates vary but generally range between 60% to 80% of patients experiencing significant relief post-surgery.

2. Decompression Techniques

• Laminectomy: This procedure involves removing part of the vertebrae (lamina) to create more space for nerves and reduce nerve compression. This is particularly effective in cases where scoliosis results in spinal stenosis (narrowing of the spinal canal) and nerve impingement.
• Discectomy: In cases where scoliosis has caused disc herniation, a discectomy may be performed to remove the affected disc portion to relieve pressure on spinal nerves.

3. Osteotomy

• Purpose: An osteotomy involves cutting and removing portions of the vertebrae to correct severe deformities or balance the spine. This approach is typically used in patients with long-standing, rigid scoliosis curves.
• Types of Osteotomies:
  • Smith-Petersen Osteotomy: Removes bone from the back of the vertebrae to allow the spine to bend forward.
  • Pedicle Subtraction Osteotomy: Removes a wedge of bone from the vertebra to provide a more significant correction.
• Pain Relief: Osteotomy, combined with fusion, can be effective in reducing pain by achieving a more balanced alignment and preventing compensatory curves and imbalances.

4. Vertebral Body Tethering (VBT)

• Procedure Overview: VBT is a newer, non-fusion surgical approach where a flexible cord, or tether, is attached to screws in the vertebrae. Tension on the tether helps to correct the curvature while preserving spinal motion.
• Patient Suitability: VBT is generally reserved for adolescents with moderate scoliosis who are still growing. It may be used for pain in select adult cases, though research is ongoing.
• Pain Relief and Outcomes: Early studies suggest that VBT can be beneficial for pain relief and offers the added advantage of preserving mobility compared to traditional fusion.

Patient Selection Criteria for Scoliosis Surgery

Determining which patients are appropriate candidates for scoliosis surgery is crucial for successful outcomes. Key criteria include:

• Severity of Pain: Surgery is considered if pain is severe, chronic, and unresponsive to non-surgical treatments.
• Curve Severity: Surgical intervention is often recommended for curves greater than 45–50 degrees, as these are more likely to progress and cause further discomfort.
• Functional Impairment: Patients with significant functional limitations due to scoliosis may benefit from surgery.
• Age and Overall Health: Younger patients and those in good health typically have better surgical outcomes, though recent advancements have allowed older adults to benefit from these procedures as well.

Risks and Complications of Scoliosis Surgery

Like all major surgeries, scoliosis surgery has risks, which include:

• Infection: Although rare, infections may occur around the surgical site and require antibiotic treatment.
• Nerve Damage: There is a small risk of nerve injury that could lead to weakness, numbness, or paralysis.
• Hardware Failure: In some cases, rods or screws may break or become loose, necessitating further intervention.
• Non-Union: Sometimes, the fused bones do not heal as expected, resulting in a non-union that could require additional surgery.
• Adjacent Segment Disease (ASD): Fusion can place stress on vertebrae adjacent to the fusion site, potentially causing degeneration over time and necessitating further intervention.

Postoperative Recovery and Rehabilitation

Recovery from scoliosis surgery is gradual, often requiring several months for initial healing and up to a year for full recovery. Key elements of postoperative care include:

• Pain Management: Initial pain after surgery is managed with medications, gradually tapering as healing progresses.
• Physical Therapy: Rehabilitation programs help restore strength, mobility, and function. Therapy typically starts with gentle exercises and progresses to more rigorous activities.
• Lifestyle Modifications: Patients are advised to avoid activities that could strain the spine, including heavy lifting or high-impact sports, especially in the initial recovery period.

Outcomes and Long-Term Efficacy

Studies show that approximately 70–90% of patients experience significant pain relief after scoliosis surgery, with many reporting improved quality of life and function. Long-term follow-ups have shown that while spinal fusion can relieve pain, patients may experience stiffness or limitations in motion, particularly with extensive fusions. Nevertheless, satisfaction rates are generally high, and advances in surgical techniques have improved outcomes and minimized complications.

Conclusion

Scoliosis surgery is a complex yet effective treatment option for patients suffering from severe pain due to spinal curvature. While it carries certain risks, the success rate is high for those who meet the criteria for surgical intervention, and most experience substantial pain relief and functional improvement. With advancements in surgical techniques and a greater understanding of scoliosis pathology, scoliosis surgery continues to evolve, offering hope and improved quality of life to many patients dealing with this challenging condition. For those who suffer from Scoliosis Pain, there is hope.  The Southwest Scoliosis and Spine Institute with offices in  Dallas, Plano, and Frisco, Texas can make your life better without pain.  When it comes to scoliosis we are among the world’s best doctors.  Give us a call today.