Spinal Deformity Surgery

Surgery :: Anterior lumbar interbody fusion :: Anterior Cervical Decompression Fusion
Lumbar Disc Replacement :: Posterior Cervical Spine Surgery :: Lumbar Decompression and Fusion
Lumbar Discectomy :: Surgical Risks :: FAQ

What is the cause of a spinal deformity?

Scoliosis (abnormal sideward bending of the spine) and kyphosis (abnormal forward bending of the spine) can result from numerous causes. In a majority of adolescents, the exact cause is unknown (idiopathic) and in others it can be caused by congenital vertebral anomalies or as a manifestation of some other disease (eg neurofibromatosis, paralytic disorders etc). In adults, spinal deformity can be due to degenerative conditions, previous spinal surgery or even childhood deformities that have persisted. Some of these deformities can progress and need treatment.

When is surgery indicated for a spinal deformity?

In adolescents and children, surgery is indicated when curve progressive occurs or is anticipated, or to correct a cosmetic deformity that is unacceptable to the patient. In adults, pain relief and improving function may be additional considerations.

What are the surgical options for the correction of spinal deformities?

There are a number of alternatives in spine deformity surgery:

• An anterior procedure (from the front through the chest wall or abdomen) removes discs and corrects the deformity and maintains the correction with rods and screws inserted into your vertebral bones.
• Posterior surgery (from the back) can also be performed using rods, screws and hooks to correct the deformity and fuse the spine.
• Occasionally, a combination of an anterior and posterior procedure is needed, which can be done in one or more stages. Bone may be taken from your pelvis to assist in the spinal fusion. Your surgeon will discuss these options with you and decide which option is best suited in each case. Your surgeon and clinical co-ordinator will explain the surgical procedure to you in detail with the help of models and diagrams. Do not hesitate to clarify all your doubts prior to surgery so that you have a better understanding of and realistic expectations for the surgical procedure. Since there are many surgical options for the correction of spinal deformities, the precise surgical procedures will not be detailed here.

After surgery

In the recovery room: Following surgery, you will usually be transferred to the Intensive Care Unit (ICU) and may feel some pain at the operated site when you wake up. A patient controlled analgesia (PCA) pump will be provided, which releases a small dose of pain medication every time you press the button thereby putting you in control of your pain. You will be given intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. You may have a drainage tube from your surgical site or from you chest to help prevent the collection of blood in these areas. You may remain in the ICU for 24-48 hours and will be transferred to your room in the ward when the surgical team is satisfied with your progress.

In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. The drainage tube, urinary catheter and pain pump will be removed in 24-48 hours and you will be encouraged to walk around. You will stay in the hospital for 5-7 days and your surgeon will decide when you can go home depending on your wound healing, ambulation and pain status.

Pain relief: Medications will be provided to reduce your pain after surgery and for the first 2 to 3 weeks at home. However, if you have excessive pain while you are in the hospital, the attending nurses should be informed.

Are there any risks involved in disc surgery?

All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. The risks may be associated with the anaesthesia given or the surgical procedure. The surgical complications include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, or injury to the nerve tissue or its surrounding protective layer.

Injury to the nerves may occur during surgery, resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.

Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.

Venous thrombosis (DVT - clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs, although we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.

The insertion of the screws can potentially cause nerve injury, resulting in weakness and abnormal sensations in the legs. Great care is taken to ensure the accurate placement of the screws, including the use of intra-operative fluoroscopy (x-rays). Correction of the deformity can also cause stretching of the nerves and spinal cord and may result in nerve injuries.

Another potential risk is that the fusion may not become solid, resulting in non-union, or pseudarthrosis. This may require a repeat surgery after a few months to supplement the bone graft to obtain a solid bony fusion.

There are certain warning signs you should look for after surgery that may indicate a problem, such as excessive bleeding, redness or discharge from the wound, fever, weakness or numbness of the legs or problems urinating. If you notice any worrisome symptoms, notify your surgeon at once.

Talk to your surgeon

This is a brief overview and does not include all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his or her team. It is important for you to obtain a clear understanding of the surgery and potential risks and benefits before you sign the consent form.