Scoliosis Surgery

• Estimated cost of Scoliosis Surgery in India ranges betweenUSD 11000 to USD 13000.
• Depending on curvature of the spine, the success rate of Scoliosis surgery is85- 90%.
• The required stay in hospital is of 6 days and 21 days outside the hospital.
• Tests required prior the surgery includes Blood Tests, X-Ray and MRI.

Treatment Cost

More About Treatment

Spinal Fusion Surgery for Scoliosis involves anchoring medical implants like hooks, screws, rods or wires to the curved bones of the spine and straitening it. This is followed by putting bone grafts over the spine. These grafts usually taken from the pelvic bone of the patient eventually grow and fuse together correcting the curvature of the spine.

• Spinal curve is nearly 45 degrees at the time of skeletal maturity.
• A Scoliosis curve of nearly45 degrees at the time of skeletal maturity is most likely to persist curving with age. With advancement of adulthood, the spine could curve further by 1 or 2 degrees every year which could lead to acute deformity making treatment at that time much more difficult.
• Spinal curve is nearly 40 degrees even after bracing.
• If the curvature of the spine has reached 40 degrees even after bracing in a growing teenager, surgery would be advisable to ensure better results and decreased duration of time spent in a brace.
• The spinal curve hinders daily routine of activities
• There is severe back pain due to Scoliosis or difficulty in breathing

Helpful:What causes Scoliosis?

Diagnosis

• X Ray and Blood Tests will be conducted
• Evaluation by the anesthesiologist as this surgery is done under general anesthesia

Several techniques can be used to treat Scoliosis through spine surgery. These vary according to the age of the patient, location of the spinal curve, spinal maturity and severity of the spinal curve. The clinical observation of the surgeon and the preference of the patient and parent in case the patient is a child also influence the technique adopted for the surgery.

Techniques can also vary depending on what kind of medical implants are used and whether the surgery is done from the back called the posterior approach or is done from the front of the body called the anterior approach.

Read:What are the forms of treatment available to treat Scoliosis?

• Spinal Fusion for Scoliosis can be done in several ways, however most techniques involve use of screws and hooks. These are attached to the bones for anchoring long rods.
• After this the affected segments of the spine are repositioned with the help of rods. The segments are repositioned to align the spine correctly reducing the lateral twist.
• Bone grafts are then introduced into the segments where fusion is required. These bone grafts may belong to the patient (auto graft) or may be taken from a donor (allograft).
• The fusion of bones takes place within 3 to 6 months and continues for about 12 months. The rods hold up the spine till complete fusion has taken place and the new bones are able to take the load of the spine. However, rods are not removed afterwards since that would involve another surgery. Sometimes the rods may cause irritation of the soft tissues present around them and may require removal.

• Post operative recovery takes place several months
• However the hospital stay varies only between three to seven days
• Since it is a painful procedure, an epidural catheter may be inserted to control pain in the back of the patient. This is removed on the third day.
• The patient’s mobility is restricted and for this a catheter is connected to the urinary bladder which may also be removed on the third day after the surgery
• The patient is kept under the supervision of a physiotherapist who helps the patient to achieve the targets of mobility and movement.
• X-Rays are taken before discharge to check the condition of the spinal cord. If there is an indication of a complication, follow up procedures are taken to restore the well being of the patient.

• It takes several months for the patient to resume movement and normal activity. Regular X-Rays and follow up examinations have to be done to make sure that the recovery is on track.
• The activities of the patient are limited. In the first six months, only simple daily routines are allowed.
• In the next two months, the patient can begin to swim.
• In 8-10 months after operation, the patient can resume exercise like bicycling.
• After 10-12 months, running, jumping and sports is allowed.
• After this, the patient’s progress is checked with an X-Ray and the patient can resume normal activities without any restrictions.

• Paraplegia or loss of movement in the lower parts of the body- Since this is a very calamitous complication, some tests like SSEP (Somato Sensory Evoked Potential) and MEP (Motor Evoked Potential) are used during surgery to keep a check and monitor if the spinal cord is compromised at any stage of surgery. If any of these tests indicate a complication, the surgery is reviewed immediately and further course of action is taken to restore the health of the spinal cord.
• Severe loss of blood-Since Scoliosis spinal surgery is a major operation, there is a lot of area exposed during surgery. The surgery also involves stripping of muscles. These complex factors can lead to severe blood loss. However with modern techniques, it is possible to keep the blood loss to reasonable levels. Patients can also be given their own blood that is donated prior to surgery and transferred later.
• Infection
• Leaking of Cerebra Spinal fluid
• Failure of Instrumentation
• Failure of spinal fusion

Recommended:When to consult a doctor!

• Condition of the patient– If the patient’s condition is complex then the treatment becomes extensive, requiring additional resources
• Type of Material Used– The cost of the various metal implants used such as hooks, rods and screws varies and thus affects the cost of surgery
• The fee of the surgeon– Depending on the choice of the surgeon, the fee of the surgery may vary accordingly
• Hospital stay– Scoliosis Spinal Surgery is a major operation requiring 7 -8 days stay at the hospital which adds to the cost of surgery

FAQs

Q: What are the chances of the rod breaking?
A: The rods used in this surgery are usually made of stainless steel or titanium. However, these can break due to stress if the spine has not fused. In such a case, another surgery may be required to replace the rods and revise the fusion.

Q: Does Scoliosis spinal surgery increase the risk of developing arthritis?
A: Arthritis is a general condition that may occur with age due to wear and tear in anyone with or without Scoliosis. In Scoliosis patients, the chances are higher, because of the twisted spine which causes intensified load over a small area.However, experts believe that in Scoliosis patients with larger curvature of the spine, the risk of developing arthritis can be lowered if they undergo surgery.

Q: Which is a better choice for bone graft – my own or an allograft?
A: Bone graft from the patient’s own body is usually a good choice for Scoliosis spinal fusion surgery. However, many times the patient complains about pain at the donor site. In rare cases, fracture, bleeding, infection may also happen at this site. To avoid this surgeons opt for allograft or bone graft from a deceased donor. Sterilized thoroughly, this allograft is combined with the marrow of the patient to enhance its capability of fusion.

In recent times, surgeons have also started using artificial products such as BMP, Bone morphogenetic protein along with patient’s own graft or an allograft. These stimulate growth of bone or act as a support for new bone formation.

The surgeon’s expertise, experience and preference are also essential deciding factors in choosing the bone graft for your surgery. You can consider all options with your family and then finalize which approach suits you best.

Q: What is long fusion and what are its side effects?
A: When the whole spine undergoes spinal fusion surgery, it is called long fusion. It is required in some patients of Scoliosis. In this surgery, the lower spine area has to bear more stress even in normal activities like bending, jumping, lifting, twisting or running. This may result in early development of arthritis in this region.However, patients with Scoliosis also tend to develop early arthritis in the part of the spine that is twisted even when they do not undergo fusion surgery.

?Q:What are the chances of back pain after surgery?
A: Some patients have back pain after the spinal fusion surgery. It is normally in the upper back or lower spine region. However, it can be easily treated with exercise and other simple measures like medications. But in some cases revision surgery to ease back pain or remove the implants may be required.

Q: Does the spinal fusion scoliosis surgery affect height?
A: Scoliosis Spinal Fusion Surgery straightens the spine. It will surely make the patient look taller. However, it will stop spinal growth in the spinal region that has been fused. But since this surgery is performed only after skeletal maturity, there might be only a minimal affect on the height of the patient.

Q: Will the hump on the back straighten after surgery?
A: A hump in Scoliosis is usually due to the twisted spine becoming prominent or the bent of the ribs. Surgery makes this bent smaller but it will not totally disappear. The surgeon can give the exact picture of how much deformity will be improved after the surgery.

Q: Is there a risk of paralysis after surgery?
A: Like any other surgery, Scoliosis spinal fusion also has several risk factors involved. These include paralysis and some other neurological complications. However the percentage of these potential risks actually occurring is low.

Q: Can women patients bear children after surgery?
A: Yes, conceiving is not generally hindered after this surgery unless some other limiting factors are also involved. This surgery also does not mean that such women will have to undergo only C-section for delivery as it does not affect undergoing natural birth process.

Q: Are the scars after surgery noticeable?
A: The length of the scar from spinal fusion surgery depends on the area and number of vertebra that are fused. It also depends on whether posterior or anterior approach has been used for surgery.In the posterior approach, you can typically expect a single scar of 6-12 inches while in the anterior approach, there could be 3-4 incisions measuring nearly 4-6 inches. However, this length varies from person to person.

Q: How does this surgery affect the flexibility of my back?
A: Spinal fusion surgery reduces the flexibility of the back but this depends on which region of your back is fused and the length of the spine involved.Surgeries in upper cervical region limit movements of the neck while those in the middle impact forward bending slightly. But surgeries in the lumbar region affect flexibility and restrict certain movements.

Q: Is wearing a brace must after this surgery?
A: A brace supports the spine and keeps it immobilized after surgery to enhance healing. With modern instrumentation techniques, the need for a rigid brace is much reduced. A corset or a soft brace can be used to support the muscles.

Q: How many times will I need to visit the hospital after surgery?
A: Spinal surgery for scoliosis is a major operation and requires long recovery period. During this time post operative visits and follow up checkups are a must to ensure that the recovery is on track. The number of appointments usually depends on the patient’s age, health condition, medical history and the surgery being performed. Generally the follow up is done in the second and sixth week after surgery followed by checkups in the third and sixth month.

Q: When can I travel by plane?
A: It is recommended not to travel by plane within 6 weeks of undergoing a surgery under anesthesia. However, a short flight of one-two hours may be taken if absolutely necessary. You must make sure to keep yourself well hydrated and active by moving around regularly.

Q: Will I have problem walking through the airport metal detector?
A: Usually the implants used in this surgery do not trigger walk through metal detectors in the airport. However, the implants near the surface may be detected by the hand-held metal detectors. But your hospital/surgeon can issue certificate for this to avoid any problems during your travel.