By David K. Wolpert
Which surgical approach is better: anterior or posterior?
In the hands of a skilled surgeon, neither approach is clearly superior. If your curve is largely in your lumbar region, an anterior approach (from the front and side) may preserve one or two vertebrae from requiring fusion, which will help maintain your bending flexibility. The anterior approach also leaves a smaller scar. However, the anterior approach has a higher rate of surgical complications and may therefore not be appropriate for all patients. Most scoliotic curves are mainly in the thoracic region, which the posterior approach can generally correct more effectively and with less risk. Patients with more severe curvatures or special situations may require surgery using both approaches. This is discussed in the book, along with two other surgical options—the endoscopic/thoracoscopic approach, and the short segment bone-on-bone technique.
How long will I be in pain after surgery?
Unfortunately, no one can predict how much or what kind of pain you will experience, or for how long, or how drugs may affect it. Every person experiences pain differently. Many people who have just had scoliosis surgery report significant pain for the first few days, then a lower level but continuous amount of pain for the next few weeks. Some find this pain debilitating, while others would describe it as a constant annoyance but tolerable. People describe the pain in different ways; for example, some have sharp pains, some have generalized pain or numbness, and some people's backs feel painfully stiff. Many people also report severe pain where bone was removed for grafting purposes (a rib or from the hip) that is sometimes worse than the pain around the spine or incision site. Your doctor can prescribe powerful painkilling drugs to help combat the pain, though you may find that certain over-the-counter painkillers may provide just as much relief.
How soon after surgery can I return to my normal activities?
This depends on many factors: the extent of your surgery, your age, and on what activities you normally do. Most people are able to return to daily activities such as driving and routine household chores within a month. Younger people, or those with more minor surgeries, are typically able to return to such activities a bit sooner. However, every patient should avoid high-impact activities (such as running or football) or activities in which you could fall or otherwise be injured (such as skating) for up to a year after surgery. It can take a year or more before your spinal fusion has completely solidified, and it is important that you do not exert significant force on your spine during this time. Using common sense and trusting what your mind and body tell you are key.
How much flexibility will I have after surgery?
This depends largely on how many vertebrae are fused, and where in your back these vertebrae are located. Fusing just the middle of your back (the thoracic vertebrae) will not significantly impact your forward bending flexibility, since these vertebrae connect to your ribcage which is fairly rigid, anyway. Fusing the upper back and neck (the cervical region) will limit the bending and twisting flexibility in your neck somewhat, but usually not severely. The five lumbar vertebrae at the base of your spine are the most important for bending flexibility. Fusing just the top lumbar vertebrae (called L1) will not impact flexibility much, but the bottom four (L2 through L5) need to be free to maximize mobility.
How long will I need someone to take care of me after surgery?You will need some help after surgery to help you cook, clean, bathe, shop, and do other routine activities that you will initially find difficult to do. How long you will need assistance depends on a few factors. If you are young, generally healthy, and have a relatively straightforward surgical procedure, you will probably be mostly self-supportive in about three weeks. Older patients, or those who are in otherwise frail health or need to have more complex surgeries, may require fairly constant assistance for six weeks to two months. Your character plays a role, too. Some people are determined to do things on their own and never ask for help, while others are perfectly comfortable with others doing things for them. It is important that you do not push yourself too hard. You will need plenty of rest after surgery, and you do not want to put unnecessary strain on your back. The book offers specific suggestions about establishing a postoperative support system.
Are there any non-surgical options to correct scoliosis?There is currently no way to permanently reduce a scoliotic curvature without surgery. For adolescents, wearing a brace until fully grown may prevent a curve from getting worse, but it will not reduce the severity of the curve. Adults may be able to control their pain, improve their posture, and even slightly reduce a curve temporarily with exercise, yoga, chiropractic care, massage, and other treatments, but again this will not result in any permanent correction. Chapter 3 is devoted entirely to discussing alternative treatments.
How much correction should I expect?The extent to which surgery can straighten your spine depends on several factors, which are explored in more detail in the book. The primary factor that determines the amount of correction achievable is the current level of flexibility in your spine. Simply put, the more flexible your spine is, the more it can be straightened. A spine becomes less flexible as one ages. Therefore, young children and some younger adults with highly flexible spines can often get as much as 70-80% correction, whereas older patients with less flexible spines may only get 40% or so correction. These are just ballparks; you may get far more or far less correction depending on a variety of factors.
How noticeable will my scar be?The length of your scar will depend on how many vertebrae are fused and which surgical approach (posterior or anterior) is employed. The more vertebrae that need to be fused, the longer an incision the surgeon must make to access them. A typical posterior approach (from the back) surgery might result in a scar 6-12 inches in length, roughly straight down the center of your back. A typical anterior approach (from the front and side) might result in three or four parallel incisions, each perhaps 4-6 inches in length.
Can the rods break?One of the myths about modern scoliosis surgeries is that the rods break. While this may be theoretically possible given some significant manufacturing defect in the rod's construction, the rods are incredibly strong and do not break unless the underlying spinal fusion was not solid. If the vertebrae are not successfully fused together, the hooks and screws that connect the rods to the spine may fall out or fall off because they lack a solid foundation. If the hooks or screws detach, the rod may detach, too. It is then possible that the loose, floating rod will bend and flex so much that it eventually wears out and then may fatigue and crack. This situation is exceedingly rare given modern surgical techniques and instrumentation. Younger patients have even less to worry about, since their successful fusion rates are very high and thus the foundation for the hardware should be quite solid. Really, this is not something to worry about.
Will I need additional surgeries later?The majority of patients who have had scoliosis surgery in the last ten years or so will never require additional spine surgery. The use of modern segmental instrumentation and better surgeon training usually obviates the need for any further surgeries. Some patients, however, will later require less dramatic surgical procedures to address problems that are often associated with scoliosis, such as ruptured discs. Patients who had surgery more than ten years ago using the now obsolete Harrington Rod instrumentation frequently develop problems that require additional surgeries (called revision surgeries) to correct.