The treatment options for scoliosis continue to advance along with the new knowledge that genetic testing for idiopathic scoliosis can give us in children and adolescents. In addition, new predictive data which helps measure the long term effect of scoliosis and spine related disability in young and older adults may allow more innovative treatment options.
Scoliosis results from an abnormal curvature of the spine when seen from the back. When the curvature is more than ten degrees, scoliosis is present. Depending on the cause of the scoliosis, a variety of treatment plans are available including nonsurgical options such as bracing or physical therapy. If the disease progressively worsens, surgical options may be necessary.
|Before surgery.||After surgery.|
Using a few small incisions instead of a single long one, and also using muscle sparing surgical approaches, many scoliosis curves can be reconstructed with similar results to traditional open approaches. When surgeons use a minimally invasive approach there is less scarring, less muscle dissection, less chance of tissue complications and less blood loss. Other advantages include shorter hospital stay, less pain, and because of the muscle sparing approach, faster return of function.
A minimally invasive scoliosis treatment now available is vertebral body stapling. This procedure involves placing staples along the vertebral growth plate to modulate the asymmetrical growth. By slowing the anterior growth of the spine, the lateral side can catch up. Two-year follow-up studies show that 80 percent of the patients had either stabilized or improved results.The best outcomes were among children 8-11 years old. Vertebral body stapling is an innovative, minimally invasive approach that is an alternative therapy for early onset scoliosis.
The best patients for vertebral body stapling have a curve between 25 degrees and 35 degrees and are between the ages of 8-11 years-old. The staples are made of a substance called nitinol, a nickel-titanium alloy that has “shape memory.” When the staples are cold, they can be in an open position for surgical implantation. When they warm to body temperature, they resume their original shape and clamp onto the vertebrae. The metal flexes and allows for continued movement of the spine. Even the most intense athletes can resume their activities after recovery.
Video assisted thoracoscopic surgery allows entry into the chest wall or thoracic cavity using a minimally invasive approach. With an incision of 4-8mm, the surgeon is able to access the thoracic spine safely, and perform a variety of techniques, including vertebral body stapling, release of severe scoliotic curves, and reconstruction and fusion if necessary. Benefits of video assisted thoracoscopic surgery (VATS) include less post-operative pain, shorter hospital stay, faster recovery, and most importantly, less impact on short and long term lung function.