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Latest Advances in Scoliosis Surgery

Researchers have been constantly working on advanced techniques to treat scoliosis efficiently and today there are quite a few surgical treatments which claim to treat scoliosis. Most of the procedures performed for scoliosis essentially includes usage of implants screwed into your spine to prevent the further bending of your spine, fusion of the discs that is intended to reduce the chances of further curvature, and ostectomy (Surgical removal of pieces of bone).

Patients are often reluctant for invasive procedures like spine surgery and the surgery per se has its own drawbacks from the patient’s perspective in terms of pain, need to go under anesthesia and the unpredictability of the results after going through such tedious invasive procedures.

In recent times, few newer techniques are said to have an impact in treating scoliosis. They are:

  1. Anterior Scoliosis Corrective Surgery (VBT)
  2. Magnetically-controlled Growing Rods (MCGR)
  3. Apifix

1) Anterior Scoliosis Corrective Surgery (VBT)

Anterior Scoliosis Corrective Surgery also known as the Vertical Body Tethering (VBT) is one of the recent techniques for scoliosis treatment. You will be asleep on your side, when your surgeon makes an incision there. Lowermost rib will then be removed followed by removal and/or reshaping of a few discs. A bone graft material will be placed between some of the discs to facilitate their fusion.

VBT is not effective in treating scoliosis of adults. For growing children, surgical treatment will be traumatic both mentally and physically. VBT is a recent advent in the field of scoliosis treatment and the research on the same is still in progress.

Although said to be effective, the possible risk associated with the procedure needs to be addressed. The surgeon will have to place an incision good in size on your side to gain access to your ribs and spine which will create a scar. This makes the procedure esthetically unpleasant. This procedure can be included in the category of major surgery and the patient will have to go under general anesthesia.

Scars formed from different spine surgeries

Apart from the invasiveness, surgery can also cause other problems like pain after surgery and the need to immobilize your whole body for a large amount of time. This surgery will result in a sudden anatomical and structural shift in the body which is also found to affect your normal respiration and also your heart rate as the surgery can have an effect on the position and function of certain organs within your body.

The other risks associated with this procedure can be infection, neurological complications, loosening of the screw which will necessitate a second surgery and the possible undesirable ramifications aren’t well documented.

2) Magnetically-controlled Growing Rods (MCGR)

The MCGR works by external remote control outside of the child’s body to lengthen the magnetically controlled rod as a child grows. The surgeons believes that MCGR is a minimally invasive procedure, however your child will have to go through an initial surgery for the implantation of the screws to the growing spine which will then be controlled with the magnetic device outside the body.

The screws will be surgically attached to the spine above and below the curve which are then lengthened during the follow up surgical procedures. This is done to allow the spine to continue growing while managing the curve until the child is old enough for a spinal fusion surgery.

Scoliosis-hires

Alastair Beaven in 2018, in his study on (MCGR), found that the chances of failure of this technique is 29- 50 percent among children treated for scoliosis. Beavaen found these results over an observation period of 2 years. This raises a question about the predictability and uncertainty of this procedure even though some of them are told to be effective.

MCGR can also have some technical complications such as loosening of the screw, failure of the rod to lengthen, fracture of metalwork and also deep infections that may require repeated surgeries. In addition, some of the cases have reported no improvement in the Cobb angle after the procedure.

This procedure does not eliminate your need for a surgery as it appears, it in fact may require multiple surgeries or at least a second surgery for spinal fusion after your child reaches skeletal maturity. Furthermore, your child will have to go through the physical and mental trauma of multiple visits to tighten and/ or lengthen the implanted screws as explained by Dr. Shannon Kelly herself, an orthopedic surgeon at Washington, US.

FACT CHECK

“Our series is the most comprehensive MCGR series published to date, and we present a mechanical failure rate of 29%. Clinicians should be mindful of the discrepancies between ERC length and radiographic measurements of rod length; other modalities may be more helpful in this regard”

Author: Alastair Beaven
Asian Spine Journal, 2018

Surgical procedures can also have a negative effect on your child’s overall growth according to the experts. Bone tissues of children are very sensitive to injuries. Bone is a dynamic tissue and until skeletal maturity is achieved, the bone grows in size. Procedures that involve invasive and traumatic techniques like placement of screws into the bone can result in bone growth inhibition causing growth retardation.

3) Apifix

Yet another advancement that is still in its growing phase. Apifix is a newly developed surgical treatment for scoliosis which is of a non fusion variety. It is told to reduce the curve point and is only said to be used when the risk of progression is low.

Demonstration of Apifix placed in the spine and the surgical wound

Although it is a promising procedure in scoliosis treatment, this procedure also does not eliminate your need for undergoing a surgery under anesthesia. Apifix is an implant device that will be screwed on to the spine as seen in the picture. It is a time consuming process which is done in two phases. Firstly, the implantation will require a surgery to be performed on your back that will result in a scar.

Secondly there will be “drill holes” made on the spine to screw the device. Although called as a “minimally invasive procedure”, this will require you to undergo a first surgery and does not clearly elude the need for further surgeries.

FACT CHECK

“The percentage of deformity correction with Apifix is around 50%”

Author: Yizhar Floman
BMC, Scoliosis and Spinal disorders, 2015

Apifix is technically a metallic device, a malfunction of this device or fracture of the device is one possibility that can cause complications that may rationalize the need for further invasive surgeries for the patient. Screw fracture, dislodgement and infection of the area from the surgery can worsen the condition and lead to further complications for which the treatment may be even complex and invasive.

Currently, we do not have long term clinical trials with a larger patient sample to clearly understand the success rates of this procedure.

Are newer surgical therapies reliable?

From the research and clinical point of view, they are not!

There are surgical therapies which have predictable outcomes in medicine. But for conditions like scoliosis, surgery has greater drawbacks and risks involved compared to non surgical treatment. The usage of a fancy term “Minimally Invasive Surgery” is often practiced by surgeons, however, surgery is always invasive and does not eliminate the risks mentioned in this book earlier.

What do the studies say?

So far, there have been no definitive results for the newertreatmentoptions for scoliosis anywhere in the evidence. Most of the newer therapies are in their experimental phases and thus they do not provide promising results as some of them assert. The insufficient evidences about these procedures have not been well recognized by most of the practitioners.

When newer procedures are developed and described in literature, the actual outcome of the procedure will not be proven in large samples. Every individual is different and not all procedures are suitable for all. These factors are not well considered in such studies in an attempt to promote the technique or the commercial device. This makes the reports less authentic and some of the studies are highly biased for promotional purposes by some companies.

As the techniques are changing drastically, they also call for the usage of complex equipments and instruments. This can increase the overall cost for the procedure making them unaffordable for most of the patients. With more sophisticated procedure, entails the demand for refined skills of the surgeon.

The surgeons performing these techniques require intense training in such procedures which is not easily available. Lack of adequate skills and performing a complicated procedure increases the chances of failure and results in undesirable outcomes. Also, the minimally invasive procedures can pose risks too:

  • Minimally invasive surgeries do not reduce the chances of complications like infection, bleeding and risks associates with anesthesia.
  • As the instruments have limited range of motion, there are chances of unintentional injuries to other parts of the body as well.
  • Some procedures may take longer than expected.
  • There is less vision to the surgical area that can limit the surgeon’s performance leading to a failure.

Scoliosis surgeries are mostly performed in adolescents or young children and a failure can have deleterious effect on the child’s physical and psychological development. Repeated surgeries can be traumatizing and reduces one’s self confidence too over a period of time.

“When it comes to spine surgery often less is more” – Dr. KLEEMAN

There is literally no micro or minimal invasiveness in spine surgery. Most of the surgeries are extensive and invasive in nature with its own risks involved. In addition to that, surgery requires long periods of hospitalization, prolonged recovery time and restraining from work and regular activity for a significant amount of time which can be avoided with other non surgical treatment options.

Also, not all individuals are candidates for surgery. Individuals with other diseases are contraindicated for surgery or an anesthesia fitness is not obtained easily for them. Whereas nonsurgical treatment can be safely done in all individuals with no worrying about the pain, operative complications, hospitalization and the cost factor.

It is essential to know about these facts before deciding on your treatment for scoliosis. It is a common tendency in the modern practice to promote surgery over non surgical treatments in a belief that surgery is definitive and curative. This misconception is being spread drastically among the general population and the primary motive of this book is to redefine your beliefs about the same.

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