-
The type of surgery for scoliosis depends on many factors such as age, magnitude and type of curvature. The objective is to correct the deformity and maintain the correction by operating on a minimum number of vertebra.
If the patient is skeletally mature or close to maturity, the most common operation is posterior spinal fusion to achieve bony union. This is done using metallic instrumentation such as hooks, screws, wires and bands.
In skeletally immature patients (i.e. under age 10) fusion is avoided since it halts the growth of the spine and the chest cage. Therefore, so-called “growing rods” is more appropriate at this age. These instruments allow and further stimulate growth. The lengthening of growing rods are traditionally done via additional surgical operations. Recently, magnetically controlled growing rods are used and lengthening is easily done at the clinic without pain. When skeletal maturity is reached, then posterior spinal fusion is applied to maintain the correction.
A more recent method is minimally invasive thoracoscopic anterior tethering. A polyester band is used and the surgery is done via endoscopic methods. This technique allows for correction without the need for fusion. The curve is partly corrected in the surgery; with the help of the tether it keeps correcting with time as the child grows.
Another method that aims to save motion segments is selective fusion. It’s also a fusion method, but only one curve is operated in a patient that has two or three curves. The major curve is operated, corrected and fused. The other curve or curves are spontaneously corrected and not fused. There are several criteria to judge whether the patient is appropriate for selective fusion.