The spine or backbone provides stability to the upper part of our body and helps to hold the body upright. It consists of several small bones called vertebrae that are placed one on top of the other. The spine has two curves when viewed from the side and appears to be straight when viewed from the front. When these curves are exaggerated, pronounced problems can occur, such as back pain, breathing difficulties and fatigue. Spine deformity can be defined as an abnormality in the shape, curvature and flexibility of the spine.
The different types of spinal deformities include:
There are different surgical approaches to repair these deformities. The choice of approach is based on the type of deformity, location of the curvature, ease of access to the area of the curve and the preference of the surgeon.
In this procedure, the surgeon approaches the spinal column from the front. The incision is made on the patient’s side, over the chest wall or lower down, along the abdomen, depending on the part of the spine that requires correction. The lung is deflated and a rib is removed in order to reach the spine. After the exposure of the spinal column, the disc material between the vertebrae that is involved in the curve is removed. Screws are placed at each vertebral level that is involved in the curve. These screws are attached to a single or double rod at each level. After instrumentation, a fusion is performed. The bony surfaces between the vertebral bodies are roughened and a bone graft is placed. A combination of compression along the rod and rotation of the rod will correct the spinal deformity. The incision is closed and dressed.
This is the most traditional approach made through the patient’s back, while the patient lies on his or her stomach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod is bent and contoured into a more normal alignment of the spine and is attached to correct the deformity. After the final tightening, the incision is closed and dressed.
This approach is used in cases where the curve is stiff and severe. The first approach to the spinal column is made from the front. The incision is made on the patient’s side, over the chest wall or lower down, along the abdomen. Disc material between the vertebrae is removed. This procedure requires the removal of a rib, which is later used for bone grafting.
After the anterior procedure, the wound is closed and the patient is positioned for the posterior approach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina, and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod that is bent and contoured into a more normal alignment for the spine is attached and the correction is performed. After the final tightening, the incision is closed and dressed.
This is a minimally invasive technique performed using a small video camera. The patient lies on his or her side. Four incisions of 1 inch are made on the side of the chest wall. A thoracoscope, a thin instrument with a tiny camera and light at its end, is inserted through one of the incisions. The thoracoscope transfers images of the inside of the chest onto a video monitor, guiding the surgeon to perform the procedure. Retractor, suction and other surgical instruments are inserted through other incisions. The lung is deflated to gain access to the spine. Steps involved in the anterior approach are performed, which involve intervertebral disc removal, bone grafting and instrumentation. The incisions are closed with an absorbable suture and the deflated lung is reinflated.