Back surgery for scoliosis is indicated in around 5% of cases and patients, and the parents of younger children with scoliosis, need to consider the possible complications of back surgery. Inflammation, infection, breathing problems, blood loss, and potential nerve injury are all risks associated with back surgery for scoliosis. Some patients will be more at risk than others, those who are overweight for example, smokers, and those with other compromising medical conditions such as diabetes or respiratory issues. The possible need for additional back surgery is also a major consideration when deciding on scoliosis surgery. A number of patients (around 5%) require additional surgery after just five years, and the modern techniques have not had time to establish a longer-term prognosis. The necessity of surgery based purely on cosmetic reasons remains open to interpretation, with many surgeons hesitant to perform such invasive procedures without a physiological impairment (such as respiratory complication) present.
Correction Rates for Scoliosis Surgery
Scoliosis is rarely corrected completely, but back surgery can make a significant difference to daily pain, discomfort, and self-consciousness about the appearance. Corrections rates are usually around 50% for spinal fusion surgery. The surgery itself is usually through anterior or posterior spinal fusion, depending on the site and degree of curvature. In some cases, both types of surgery are conducted during the same procedure or two separate procedures, with surgery for scoliosis often taking four to eight hours and having a significant period of recovery and rehabilitation afterwards. The incision made during back surgery for scoliosis usually runs the full length of the spine.
Risks of Paraplegia
There is a risk of paraplegia with surgery for scoliosis, although this is extremely rare and has around a 1/1000-1/10,000 chance of occurring. Some surgeons make use of somatosensory evoked potentials, and motor evoked potentials to monitor nerve signalling during the surgery. Other surgeons may use a Stagnara wake up test involving waking the patient and asking them to move their feet during the surgery. The patient does not remember being woken after surgery, and does not feel any pain during this brief period of consciousness. If nerve function appears compromised then the surgeon can cut the rods and abandon the surgery in order to reduce the risks of paraplegia. The patient will then be tested to ensure neurological function is intact and surgery can be rescheduled.
Blood Loss Durgery Scoliosis Surgery
Blood loss is a major risk during scoliosis surgery as the patient has a significant degree of muscle tissue stripped or cut during the procedures. Some surgeons ask for the patient to donate blood prior to surgery in order to be prepared for any necessary transfusion in the procedure itself. It is also possible to collect and transfuse the patients’ blood that is lost during surgery in some cases. Infection, both deep and shallow, can occur after surgery and has an incidence of around 1%, hardware failure is extremely unlikely, but remains a possibility, as does nerve damage and allergic reaction to the anaesthesia. Failure of spinal fusion to occur presents, perhaps, the highest risk, with around 1-5% of patients not achieving a successful fusion of bone.
Alternatives to spinal fusion for scoliosis do exist, with the main intention of delaying the need for fusion surgery and allowing children to grow whilst addressing some possible complications due to their scoliosis. Implants in the ribcage can help smaller children with breathing difficulties and cardiac pressure by pushing the ribs apart on the compressed side. Vertical expandable prosthetic titanium ribs (VEPTR) can successfully expand the child’s chest cavity to allow more comfortable breathing whilst exerting a straightening effect on the spine as the child continues to grow. The flexibility of the spine is, therefore, maintained due to the non-use of fusion. The VEPTR technique is only appropriate in a growing child, and is a novel operation with little in the way of long-term outcomes.