Scoliosis describes the curvatures that can be seen when the spine is viewed from the front or the back. The body is usually tilted sideways and one of the shoulders may be higher than the other. Sometimes there is a hump on one side of the back, especially when leaning down. This is because the ribs that make up the rib cage form an asymmetrical projection from the spine which is curved. Scoliosis is examined with various classifications. Scoliosis which develops with unknown causes during childhood is called “idiopathic scoliosis”, scoliosis due to neurological or muscular diseases is called “neuromuscular scoliosis”, scoliosis due to developmental anomalies present at birth is called “congenital scoliosis”, scoliosis which can be seen with the degeneration in older people is called “adult scoliosis”. Here, next generation scoliosis surgeries applied in “idiopathic scoliosis” which are mostly seen in adolescence will be explained.
Patients with suspected scoliosis usually need to be examined radiologically after the physical examination. Other anomalies that may accompany scoliosis are also ruled out in detailed examinations. After these detailed examinations, the form of treatment is decided. Some scoliosis cases are just followed up by conservative treatment options, while others need surgical treatment. While it is sometimes necessary to recommend a corset to be used for scoliosis patients, sometimes exercise programs are recommended by physical therapists. Severe scoliosis can only be treated surgically. The main purpose of classical surgical treatment is to correct the curvature of the spine and keep it that way throughout the lifetime of the patient. To do this, the spine is fused with metal (usually titanium) screws and rods.
New methods are being developed for the treatment of scoliosis to reduce the operation area, to keep the spine moving and to allow the spine to grow. These new techniques can be applied to many patients as they are developed, however, it takes time to get scientific results from large patient groups. In addition, it should not be forgotten that every patient is different and every procedure and intervention is not appropriate for everybody. When surgical techniques change, more complex tools and instruments are often required. With these new technologies, the cost is higher, and the surgeon’s training and surgical skill are expected to be higher for a more difficult and sophisticated procedure.
Minimally invasive surgery is to complete the planned surgical procedure with the smallest skin incision, muscle retraction and opening possible. As a result, less pain, smaller surgical scars, less bleeding and fewer complications are expected. While this technique is used in many diseases in spine surgery, its use in scoliosis surgery has started to increase in recent years.
One of the most important recent developments in scoliosis surgery is “scoliosis anterior correction surgery” which is also known as “non-fusion scoliosis surgery” (VCT, vertebral body tethering). This method is both minimally invasive and dynamic; in other words, the spine remains mobile even after the surgery. The spine continues to grow naturally.
Implants (screws) are placed in the bodies of the thoracic or lumbar vertebrates with as small incisions as possible. Then, a cord cable is placed to connect the implants. As this cable is stretched over each vertebra, the curvature of the spine can be reduced.
Possible complications of this technique include pneumothorax, major vascular bleeding, infection, anesthesia problems, screw detachment, fracture, loosening, and neurological complications. As it is a newly developed method, long-term results regarding its effectiveness and safety are not yet present.
In the magnetically controlled growing rod method (MCGR, Magnetically-Controlled Growing Rods), screws and the growing rod are placed in the first surgery. Later, in the follow-ups, the growing rod can be extended with a magnetic controller. Thus, the rod placed in the initial surgery can be elongated, allowing the spinal curvature to decrease and the spine to extend. Fusion surgery can be performed when the child reaches adulthood.
Although some studies show that this method is very effective, there are also publications indicating a significant inadequacy of this method. Complications of this method include screw loosening, not being able to extend the rod as much as desired, metal cracks, infection and inability to fix the scoliosis sufficiently.
Video-assisted thoracoscopic surgery (VATS) is an approach that allows entering from the chest area with a minimally invasive approach. With a small incision, the thoracic (back) spine can be reached safely and many surgical procedures can be performed. The thoracoscope used in this method provides a very detailed anatomical view to the surgeon with video systems and high resolution cameras. Screws can be placed in the vertebral bodies, heavy scoliotic curvatures can be loosened, removable implants can be placed with cord systems (VBT, vertebral body tethering) or fusion can be performed with rigid systems. This minimally invasive surgical method has important advantages compared to open surgery, such as less pain, short hospital stay, faster recovery and less impact on lung functions.
