Prof. Dr. Erkan Kaptanoğlu

New Generation Scoliosis Surgery

Scoliosis describes curvatures of the spine that are visible when viewed from the front or back. The body is often curved sideways and one shoulder may be higher. Sometimes there is a hump on one side of the back, especially when bending forward. This is caused by the asymmetrical protrusion of the ribs forming the rib cage backwards.

Scoliosis is classified in various ways. Scoliosis that develops in childhood for unknown reasons is called idiopathic scoliosis, scoliosis due to neurological or muscular diseases is called neuromuscular scoliosis, scoliosis due to developmental anomalies of the spine present at birth is called congenital scoliosis, and scoliosis seen with degeneration in older people is called adult degenerative scoliosis. Here, new generation scoliosis surgeries for idiopathic scoliosis, which is mostly seen in childhood, will be explained.

Patients with suspected scoliosis usually need to be examined radiologically after the examination. In detailed examinations and investigations, other anomalies that may accompany scoliosis are also ruled out. After these detailed examinations, the type of treatment is decided. While some scolioses are followed up with conservative treatment, others need surgical treatment. For scoliosis that is followed up, sometimes a brace is recommended, while sometimes they are included in exercise programs by physical therapists. Advanced scoliosis is treated with surgery. The main aim of classical surgical treatment is to correct the curvature of the spine and keep it that way. To do this, the spine is fixed with metal implants (usually titanium) screws and rods and fusion is performed. 

New methods are being developed in the treatment of scoliosis to reduce the operating area, keep the spine mobile and allow the spine to grow. As these new techniques are described and developed, they are applied to many people, but it takes time to get scientifically based results on large groups of patients. In addition, it should not be forgotten that every patient is different and not every procedure and intervention is suitable for everyone. When techniques change completely, more complex tools and instruments are often required. Surgical skills are also expected to be high in these new technologies.

Minimally invasive surgery

Minimally invasive surgery is a surgery planned with the smallest possible skin incision and muscle retraction. As a result, less pain at the wound site, 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.

VBT, vertebral body tethering

One of the most important recent developments in scoliosis surgery is “scoliosis anterior correction surgery”, also known as VBT, vertebral body tethering. This method is both minimally invasive and dynamic. This means that the spine remains mobile after surgery. The spine also continues to grow in its natural shape.

After the thorax is opened, implants (screws) are placed in the bodies of the thoracic or lumbar spines through as small incisions as possible. Then, a rope (cord) cable is placed to connect the implants to each other. As this cable is stretched over each vertebra, there is an improvement in the curvature of the spine. Among the possible complications of this technique, pneumothorax, large vessel bleeding, infection, screw removal, anesthesia problems, screw removal, breakage, loosening and neurological complications have been reported. Since it is a newly developed method, there are no long-term results regarding its effectiveness and safety yet.

Growing rod

In the magnetically controlled growing rod (MCGR) method, screws and the growing rod are placed in the first surgery. Then, during follow-ups, the growing rod is extended from outside the body with a magnetic controller. Thus, the rod placed in the initial surgery lengthens, allowing the spinal curvature to decrease and the spine to lengthen. Fusion surgery can be performed when the child reaches a sufficient size.

Although some studies show that this method is very effective, there are also publications showing the significant inadequacy of this method. Complications of this method include screw loosening, rod not extending as desired, metal breakage, infection and inability to correct scoliosis sufficiently.

Thoracoscopic spine surgery

Video-assisted thoracoscopic surgery (VATS, Video Assisted Thoracoscopic Surgery) is an approach that allows entry into the chest cage with a minimally invasive approach. With a small incision, the thoracic (back) spine can be safely reached and many surgeries can be performed. The thoracoscope used here provides the surgeon with a very detailed anatomical view with its video systems and high-resolution cameras. Screws can be placed in the spinal bodies, severe scoliotic curvatures can be loosened, removable implants can be placed with rope systems (VBT, vertebral body tethering) or fusion can be performed with rigid systems. This minimally invasive surgical method has important advantages such as causing less pain than open surgery, short hospital stay, faster recovery and less impact on lung functions.

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