Minimally Invasive Treatments for Patients With Scoliosis
Minimally Invasive Scoliosis Surgery
Scoliosis is a curvature of the spine. Idiopathic scoliosis develops during adolescence and consists of a curvature of the spine as well as a rotation of the vertebral bodies. Degenerative scoliosis usually develops during adulthood as a result of asymmetrical degeneration of the discs, which causes a curvature of the spine. Both types of scoliosis can become quite painful and debilitating. Progression of the deformity leads to imbalance in the coronal and sagittal planes and is often associated with compression of the spinal nerves. The patient tends to lean off to one side and leans forward due to the imbalance. Therefore, treatment must address the correction of the curve, the derotation of the vertebral bodies, and the restoration of good standing balance.
Historically, surgical techniques to correct these deformities required extensive exposure of the spine in order to visualize the deformity, do corrective resections and achieve the alignment desired. These procedures were often associated with long operative times, high volumes of blood loss, prolonged stays in the ICU (Intensive Care Unit), and extensive rehabilitation. Therefore, a less traumatic solution was sought that could achieve the same results in a less invasive way; thus, the evolution of minimally invasive scoliosis surgery.
Dr. Anand has pioneered the development and promotion of minimally invasive scoliosis surgery throughout the United States and the world. Over the past 12 years, Dr. Anand has refined a minimally invasive approach to achieve similar outcomes to traditional deformity correction with less postoperative complications and faster recovery for his patients.
Dr. Anand combines several minimally invasive techniques to achieve circumferential scoliosis reconstruction. Explore his surgical process below:
Scoliosis reconstruction is divided into two stages in order to reduce the length of time that patients are under anesthesia at one time and to allow for reassessment of the deformity between the stages for final surgical planning. The goal of the first stage is to restore the height of the disc spaces in the lumbar spine, while creating lordosis and a surface area for interbody fusion. A lateral approach is taken to access the lumbar spine through small 1-inch incisions on the side of the abdomen. Dilating tubes are passed in front of the psoas muscle down to the spine. Dr. Anand works through these tubes to expose the disc space. A series of instruments are passed through the tubes to remove the disc material and prepare the space for an interbody spacer. The spacer reestablishes the height and angle of the disc. This is repeated at each affected level.
For the L5-S1 disc space, Dr. Anand utilizes an anterior oblique approach to the spine. A 1-2 inch incision is made on the side of the abdomen. A vascular surgeon provides access to the spine. Once exposed, Dr. Anand uses a series of instruments to remove the disc and prepare the space for an interbody spacer. The spacer reestablishes the height and angle of the disc. A plate is used to secure the spacer in place.
Both of these approaches allow him to safely access the spine while preserving muscle attachments and with the least disruption of the surrounding tissues. After Stage 1, patients are monitored for 2-3 days in the hospital. Patients are encouraged to be out of bed and walking during that time. Most patients will notice improvement in preoperative leg pain after Stage 1. With the relief of leg pain after the first stage a formal decompression of the spinal canal is not needed and avoids the need for any manipulation of the neural structures.
The goal of the second stage is to stabilize the spine, reduce the curvature, and preserve the alignment. This is achieved with a pedicle screw and rod system, which is implanted using a minimally invasive approach. Multiple small incisions are made on the back, through which dilating tubes are placed. The screws and rods are passed through tubes so as to preserve the muscle attachments, contributing to the minimally invasive approach. Dr. Anand corrects the curve and alignment of the spine as he locks the rods into place. By using this minimally invasive approach, patients do not need to go to ICU, lose less blood/require fewer blood transfusions, and recover much faster, allowing them to get back to their daily activities sooner.
Conference Lecture on MIS Deformity Correction by Dr. Anand