Spinal Fusion for Scoliosis: How & Why is a Spinal Fusion Done?
Scoliosis is defined and diagnosed by an abnormal curvature of the spine. Instead of being straight, the spine deforms into a curve that when x-rayed looks more like a squirmy worm or slithering snake (sorry for this visual!). If the curvature is severe and symptomatic enough, surgery may be the next step after all non-operative treatments have failed. The surgical procedure most often used to treat scoliosis is call a "spinal fusion".
Although it sounds scary, spine surgery has come a long way in recent years. Orthopedic surgeons are more skilled than ever before and the medical procedure has become much safer. Read on as we talk out the basics of adult scoliosis, break down "why and when surgery may be the right choice", and discuss what the procedure actually looks like. Sounds good? Great, buckle up and keep reading!
Scoliosis 101: Back to Basics
Scoliosis is very common. According to the American Association of Neurological Surgeons (AANS), scoliosis affects between 2-3% of the population. There are different types of scoliosis, all of which are marked by a curve in the spine. Depending on your type of scoliosis, age of onset, and severity, the prognosis can vary. The three main categories of scoliosis are: idiopathic, congenital and neuromuscular (myopathic).
Idiopathic Scoliosis: majority of children and adults fall into the "idiopathic" category. This means that the cause of the scoliosis is generally unknown.
Congenital scoliosis: a pretty rare birth defect, detected in very young children or babies.
Neuromuscular scoliosis: a side effect of another disease like cerebral palsy or muscular dystrophy
The most common type of scoliosis is "degenerative scoliosis" aka "adult scoliosis".
Like a knee or hip joint, degenerative scoliosis is caused by aging and general wear and tear. This type, like joint osteoarthritis, develops over time, typically in the lumbar spine/ lower back. This type can be quite painful and affects many seniors. Degenerative scoliosis is similar to lumbar osteoarthritis and can cause back aches, radiating leg pain (like sciatica), numbness and/or weakness in the legs.
This study found "a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years". In other words, in a group of healthy adults, 60 years and older, 68% showed some form of degenerative scoliosis.
In sum, there are different types of scoliosis and degenerative/adult scoliosis is the most common, affecting older adults. The defining factor for surgery has less to do with type, but the severity of the deformity (curve) and how it's affecting your mobility, pain, and most importantly, your quality of life.
Read on as we talk about surgery and who may be a candidate.
When is Surgery Necessary and Why?
A spine curve of 45°-50° or greater will put you in the category of a "severe" curvature. For spine curvatures less than 45°, surgery is not generally recommended (Especially in kids and teenagers). Surgery is usually only considered when:
The deformity is worsening and the curve is becoming more dramatic.
The patient is experiencing lots of side effects like: moderate-severe back pain, trouble moving, breathing issues etc.
The surgery can help reduce the deformity. Surgery can help improve the lateral curve by 50-70% (for most but not all deformities).
Physical therapy is no longer improving mobility, trunk balance etc.
Spinal injections are not providing relief.
Medication is no longer providing enough relief.
Quality of life has gone down and a patient can no longer participate in activities they enjoy.
A patient is in good enough overall physical and mental health to recover from this invasive procedure.
Spinal fusion surgery is only reserved as a last resort for patients who meet some, or all of the above criteria. Ultimately, you and your orthopaedic surgeon will know best if surgery is the best option. It is typically used to stop the curve deformity from worsening, to improve your cure (by up to 50-70%), better your body's balance and symmetry (legs are the same length, hips properly rotated etc.)
Are you getting ready for back surgery? PreHab your way to a faster reovery with PeerWell PreHab.
What Does Spinal Fusion Surgery Look Like?
A spinal fusion will join two or more vertebrae (bones) together with or without instrumentation (like metal rods and screws). This fusion (joining of bones) is permanent. The reason for fusing the vertebrae together is to stabilize the spine in the correct position. A spinal fusion can usually correct the curve in the spine by 50-70%.
In a nutshell, here's what a lumbar spinal fusion will look like:
Anesthesia is administered. Typically, general anesthesia will be used. Learn more about the types of anesthetic used in orthopedic surgery.
An incision is made. Depending on the approach your surgeon is using, this incision may be vertical across the center of the back (posterior), on the side (lateral) or from the front in your lower abdomen (anterior). The length of the incision will depend the approach and how many vertebrae will be fused. The posterior approach is most common.
Muscles and tissues are cut and gently moved to the side to reveal the spinal column.
Part or all of the lamina, the bony posterior covering, from the vertebrae may be removed. This creates more space for the spinal cord and nerves that may otherwise be compressed by the bone. Compression of the cord or nerves is referred to as "stenosis".
Specific cuts are made in the bones and ligaments are released to realign the spine.
Typically (but not always) metal screws and rods are used to stabilize the spine and hold everything in place while the bones fuse.
The vertebrae being fused are roughened up. Bone graft (either from you or a donor) is then put in place so that your body will naturally fuse the bone graft to the vertebrae bone. This process typically takes 3 months.
Incision is closed and in-hospital recovery begins, followed by a total recovery process (lasting up to one year).
After Spinal Fusion Surgery
After a spinal fusion, you will probably stay in the hospital for a minimum of 2-3 days. This is to ensure that you are hitting the mobility milestones, and to manage your post-op pain. During your in-hospital stay, you will likely have a drain in your back to prevent a fluid collection and a catheter for your bladder.
Before leaving the hospital your care team will ensure that:
You can get out of bed and into a chair
You are able to walk around (out of room, down the hall)
You can climb up and down stairs
Your X-rays show that the implants and spine are well-aligned
You are able to be discharged home (you have support, a safe home etc.)
As outlined by the Mayo Clinic, here are signs to watch out for in your recovery. Redness, shaking, chills, fever, foul smelling wound discharge etc., are signs of an infection. Always contact your physician immediately if any of these signs appear.
In the weeks and months that follow surgery, physical therapy will be necessary to regain full mobility, and to help with pain and inflammation. In addition, an at-home ReHab program designed for spinal surgery, like PeerWell, will be very impactful on your recovery.
PeerWell's Back/ Spine PreHab and ReHab programs are designed to get you the most ready for spinal fusion surgery. Patients who use PeerWell's PreHab for spinal fusion surgery have better outcomes and a faster, safer recovery. Our continued ReHab program helps you find your new normal, safely and swiftly.
This article was medically reviewed by orthopedic surgeon, Dr. Param Singh.