SCOLIOSIS SURGERY: ANTERIOR APPROACH LIVING WITH SCOLIOSIS
Anterior spinal surgery is performed through the chest or side.
WHAT IS THE ANTERIOR APPROACH?
In the anterior spinal surgery for scoliosis, the surgeon will access the spinal column from the front rather than through the back. Technically, the surgeon makes the actual incisions in the side of the chest or abdomen rather than down the front of your body as you might assume. Using the anterior approach, surgeons can remove discs from the front of the spine (if necessary), place corrective spinal instrumentation, and perform the correction.
WHEN IS THIS APPROACH USED?
A variety of factors influence the decision to use the anterior approach for scoliosis surgery. Among them include the patient’s type of scoliosis, location of spinal curvature, severity of the curve, ease of approach to the area, and the surgeon’s preference. The anterior approach is especially conducive to certain types of scoliosis curves, such as those located in the thoracolumbar spine (thoracic and lumbar regions).
Anterior techniques can be a very effective method of correcting spinal deformities. In a scoliosis procedure, the surgeon may be able to fuse a shorter segment of the spine with this approach, thus preserving more motion in the spinal column. However, this approach is more difficult than the traditional posterior approach.
WHAT TO EXPECT DURING THE OPERATION
After you enter the operating room, you will be given anesthesia to put you to sleep. Once you are completely asleep, your anesthesiologist will place a breathing tube to help you breathe during the operation. He or she will also place a variety of catheters in your veins used to monitor your heart function, blood pressure, fluid status, and depth of anesthesia throughout your surgery. You will then be rolled onto your side.
THE INCISION
Your surgeon will make the incision on your side, either over your chest or lower along your abdomen, depending on the part of your spine that requires correction. In order to access your sine, your surgeon will deflate one lung and remove a rib. Don’t worry — your rib will likely grow back over time, especially if you are young.
SPINAL PREPARATION
Once your surgeon has exposed the surface of the spinal column, he or she will remove the disc material from between the vertebra involved in the scoliosis curve. This increases the curve’s flexibility and provides a large surface area for spinal fusion. Disc removal is an important feature of the anterior approach.
SCREW AND ROD PLACEMENT
To complete the scoliosis correction, your surgeon will place a vertebral body screw at each vertebral level involved in your spinal curve. At each level, these screws will be attached to a single or double rod. By compressing and rotating the rod, your surgeon will correct the curve and straighten the spine.
FUSION
After final adjustments have been made to the screws and rods, your surgeon will perform spinal fusion. He or she will first roughen the bony surface between the vertebrae, then pack bone graft into the space between the vertebral bodies. Bone graft may be gathered from your removed rib, the crest of your pelvis, allograft bone, or other bone substitutes. The bone graft helps the vertebrae to heal together into a solid bone.
INCISION CLOSURE
After the bone graft and fusion, your surgeon closes and dresses the wound. If your surgeon was working in your chest cavity, they will place a chest tube to help keep your lung expanded after the operation.