Deformity surgery in the spine describes those surgeries that aim to correct a mal-alignment (Like scoliosis, Kyphosis, Listhesis, etc) of the spine surgically. They may be required as a result of problems from birth, problems that arise with growth, sequalae of injury and fractures or problems that arise with the aging spine.
To understand the role of deformity surgery, one first needs to understand the aligned, balanced spine. The normal spine should appear straight when viewed from the front (coronal plane). When viewed from the side (sagittal plane) the spine has alternating, oppositely balanced, sequential curves called lordoses and kyphoses. These curves allow the spine to position the head centrally over the feet, in an upright, erect balanced posture. When the spine appears curved when viewed from the front it is described as a scoliosis. Alternatively, loss of the balance between the lordoses and kyphoses, also create mal-alignment as they usually place the head too far forward relative to the feet. The deformity not only causes a cosmetic problem, but also causes the body to use up extra energy to maintain balance. This may cause fatigue and pain in the muscles and ligaments. The loss of balance also creates abnormal and excessive wear on the joints in the spine, which can also cause more pain and premature arthritis. Other problems, related to severe deformity, arise because of structures being squeezed by the deformed bones e.g. nerves, lungs.
Thus deformity surgery is used to correct these mal-alignments and address problems related to cosmesis, chronic pain, arthritis and organs being compressed. This is done by realigning the deformed curves and getting them to join together (fuse) in the straightened position. In modern medical practice, deformity surgeries are performed by spine surgeons who are specially trained in the techniques and use an arsenal of complex equipment to achieve success rates in excess of 90% of cases. These include sophisticated monitoring devices which create early warning systems to minimize or even prevent injury to the spinal cord, and computerized navigational software to guide the surgeon in placing the implants. Typically, the surgeon will obtain imaging of the deformity with a combination or Xrays, CT scans and MRI scans. These are often input into a computer to facilitate computer navigated planning and surgery. Then, the surgery is performed by realigning the spine and then placing a combination of medical plastics, metals, screws, rods and/or plates to fuse the realigned spine until it heals. These implants may be left in place for life. Additionally, biologic material prepared in a lab or bone harvested from the patient is placed beside the spine to help it to heal in its new position. The surgery may be done from the front, side, back of the spine or a combination of these. Additionally, it may be done by an ‘open’ technique, which exposes the entire deformity for correction, or by a minimally invasive technique, which utilizes navigation to minimize the cut required to correct the deformity. When done by an open technique, the procedures can be major and require a longer hospitalization and rehabilitation than when done by a minimally invasive technique. Your surgeon will help you decide which procedure is most suitable. Unusual problems from the surgeries include injury to the nerves or the spinal cord, injury to the nearby organs, excessive bleeding, infection, and failure of the procedure. Whilst most people will be able to return to light work within 4-8 weeks, the healing process continues on for up to 2 years, and major activity (contact sports) may be restricted during this healing period. Occasionally, a brace may be required for a portion of the rehabilitation period.
Content written by Dr Kimani White & Dr Ashish Diwan