Deformity Correction for Adult Scoliosis
Scoliosis is an abnormal curvature of the spine. Scoliosis can be divided into categories depending on the age it presents and it can be treated in several ways depending on the severity of the curve and its progression. Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant deformity, or a steadily worsening curve angle. The goals of most surgical procedures for scoliosis include:
⦁ Reducing the deformity (straighten the spine as much as possible)
⦁ Stopping the progression of the deformity
⦁ Removing any pressure from nerves and spinal cord
⦁ Protecting nerves and spinal cord from further damage
The main surgery for scoliosis is spinal fusion with instrumentation. Nearly all surgeries will use implants (e.g., screws, hooks, rods, etc) in order to help straighten your spine. Screws can be placed in the vertebrae, and then connected by a metal rod. A bone graft might be put in place of the discs that were removed so that the vertebrae sitting next to each other will fuse together. Bone graft may also be placed along the sides of the vertebrae to achieve posterolateral fusion. The screws attaching the metal rod are tightened down, straightening the curve.
Anterior Cervical Discectomy and Fusion
The Anterior Cervical Discectomy and Fusion (ACDF) procedure is intended to decompress the nerve roots and spinal cord while stabilizing the cervical spine. After the soft tissue and/or bone are removed, a pathway for fusion is created by inserting an interbody spacer filled with autograft. The spacer can be made from a variety of materials such as PEEK, Carbon Fiber Reinforced PEEK (CFRP), titanium or machined allograft. In conjunction with the spacer, an anterior cervical plate is utilized to provide stability and supplemental fixation while fusion occurs. Alternatively, a standalone cervical interbody fixation device may be used that can provide an option for fusion with minimal implant profile on the anterior of the patient’s vertebrae.
Total disc replacement is an operation where a painful, degenerated disc is removed and replaced by a ball and socket implant that is intended to allow motion. In this procedure, mobility in the motion segment is retained in comparison with fusion operations where mobility is lost.
Deformity Correction for Neuromuscular Scoliosis
Neuromuscular scoliosis is an irregular spinal curvature due to abnormalities of the muscle‐nerve pathways of the body. It is generally most severe in non-ambulatory patients. Curve progression is much more frequent than idiopathic scoliosis, and may continue into adulthood. Bracing does not prevent progression of the spinal curvature. Cantilever correction maneuvers and instrumentation down to the sacrum and ilium are utilized to address pelvic obliquity, which accompanies NM Scoliosis. Compression, distraction and vertebral body derotation can be used to manage the coronal deformity of the spine.
Posterior Cervical Spine Fusion
Posterior Cervical Fusion is a procedure intended for the stabilization of the cervical spine through a posterior approach. The procedure is commonly performed using hooks, plates, screws and rods as an adjunct to the fusion. Posterior cervical fusion is performed to treat instabilities which arise from: degenerative disc disease, spondylolisthesis, spinal stenosis, fracture/dislocation, atlantoaxial fractures with insatiability, occipito-cervical dislocation, revisions of previous cervical spine surgery and tumors.
Posterior Lumbar Interbody Fusion (PLIF)
The Posterior Lumbar Interbody Fusion (PLIF) procedure is intended to stabilize the spine by causing bone to grow between the two vertebral bodies, thus limiting motion at that level. PLIF achieves spinal fusion in the low back by inserting two cages directly into the disc space and is supplemented by a posterolateral spinal fusion surgery, typically a pedicle screw construct.
Treatment for spondylolisthesis is similar to treatments for other causes of mechanical and compressive back pain. Surgery is necessary only if conservative treatments fail to keep a patient’s pain at a tolerable level. Surgical treatment for spondylolisthesis must address the presence of mechanical and compressive symptoms. Nerve pressure may require surgical decompression, called decompressive laminectomy of the lumbar spine. Patients needing surgery for spinal instability due to spondylolisthesis will typically require lumbar fusion.
Transforaminal Lumbar Interbody Fusion (TLIF)
An adaption of the posterior lumbar interbody fusion (PLIF) procedure, the TLIF technique employs a unilateral approach to the disc space through the intervertebral foramen. Requiring only a partial unilateral facet resection, the TLIF procedure when compared to a PLIF:
⦁ Preserves the laminar arch and contralateral facet
⦁ Avoids bilateral scarring
⦁ Avoids significant dural retraction which may reduce the risk of intraoperative dural tears
⦁ Offers a revision strategy that may not exist with a PLIF due to bilateral scarring
The unique unilateral TLIF approach requires specific implants and instrumentation to facilitate thorough disc space preparation and accurate cage placement.
Vertebral Body Replacement
A Vertebral Body Replacement device is designed to replace a vertebral body in the thoracolumbar spine (T1-L5) in patients with a collapsed, damaged or unstable vertebral body due to trauma and/or tumor. When implanted, the device will provide anterior spinal support and restore sagittal alignment.