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Occasionally when the curve is very severe and the discs are significantly degenerated an anterior procedure will be recommended to improve overall correction. In this case, the surgeon will go into the chest or abdominal cavity or both and gain exposure to the spine often with the help of a thoracic, general or vascular surgeon. Once the spine is exposed and all the anterior vascular structures are protected, the intervertebral discs are removed and the spine is mobilized. Generally bone graft is placed between the vertebra in the front to aid in fusion. Sometimes, metallic or ceramic like cages are placed in the spaces to aid in correction of alignment. If adequate correction is possible from the anterior approach alone, the surgeon will place a rod and screw construct to maintain alignment while the spine fuses.
Often after release anteriorly, the patient will undergo a second stage procedure to make the final correction, instrumentation and fusion in the posterior approach as described above. In rare instances, in the older patient with an essentially fused spine due to arthritis and degeneration or previous surgery, a three stage procedure is done. This involves going into the spine in the back to make cuts in the spine which essentially loosen up the joints and allow some motion to occur. Next and anterior approach is done as previously described, and finally another posterior approach is performed to complete the correction and fix the spine.
Obviously each individual patient has to evaluated as to the type of procedure required to optimize there surgical correction. Sometimes different surgeons may vary as to their recommendation as to type and scope of procedures. Often the general health and age of the patient will play a role in the decision making process. Sometimes thoracoscopic or VATS (visually assisted thoracoscopic surgery) can be done to achieve release correction and instrumentation as a minimal approach end to itself or as a part of a multistage procedure.
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Severe double major curve
scoliosis 78 degrees |
Severe scoliosis Post-Op from anterior
and posterior correction surgery |
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