Despite everyone's best efforts, some curves do not respond to bracing or are too large to respond to the brace. Surgery is required for these patients.
If surgery is necessary to treat idiopathic scoliosis or other spinal deformities, Boston Children’s uses the most advanced surgical methods for the correction of spinal deformities including:
thoracoscopic anterior spinal surgery and instrumentation for selected flexible curves
dual posterior growing rods for early onset scoliosis
hemivertebra and wedge resections for congenital scoliosis
Posterior fusion with instrumentation is the most common operation done for idiopathic scoliosis. In the posterior fusion the spine is operated on from behind with an incision straight down the back.
Various types of instrumentation are used to partially straighten the spine and hold it secure while the bone fusion occurs.
For most operations for idiopathic scoliosis, no brace or cast is used postoperatively.
In congenital scoliosis or spondylolisthesis the posterior fusion is usually done without instrumentation, and a cast or brace is needed postoperatively.
The goal of a spinal fusion is usually a solid join (solidification) of the corrected, instrumented part of the spine. A fusion is achieved by operating on the spine, adding bone chips and allowing the vertebral bones and bone chips to slowly heal together to form a solid mass of bone called a fusion. The fusion process replicates the natural process of healing a broken bone for injury.
The bone chips (bone graft) may come from your hip or from the hospital's bone bank. Often, the spine is partially straightened with metal rods and hooks or wires (instrumentation). A brace or cast holds the spine in place until your fusion has a chance to heal.
Once the fusion has healed, which usually takes six to 12 months, the abnormal section of the spine will not curve more. The instrumentation can usually be left in your back without causing any problems.
Anterior fusion is used in special instances of idiopathic scoliosis, and commonly used in other spinal deformities such as congenital scoliosis, kyphosis or myelomeningocele.
An incision is made along a rib and/or down the flank of the abdomen to obtain access to the front of the spine. A bone graft from hip, rib or bone bank is used for the fusion. Screws and washers attached to a rod may be used to straighten the spine. Fusions of this type usually require a postoperative brace.
Anterior and posterior fusion
Some special cases of spinal deformity require both an anterior (front) and posterior (back) operation. Usually, these can be done on the same day, but sometimes they must be completed during separate operations spaced one to two weeks apart.
An osteotomy is a surgical procedure that entails controlled breaking or cutting of the bone(s) and realignment into the correct position. A spinal osteotomy may be performed in cases where there is significant rigid deformity, and increased flexibility is desired before the stabilization with instrumentation and fusion.
Vertebral growth modulation
Vertebral growth modulation attempts to maintain spinal motion while preventing progression of the curve and possibly improving the curve with growth. Growth modulation by use of tether or vertebral staple may be possible when significant growth remains.