Your child’s spine deserves the expertise of our pediatric-trained spine team. Scoliosis surgery takes extensive knowledge and precision. Our surgeons are all fellowship-trained and are among the leaders in their field when it comes to spinal surgery navigation and robotics. Your child will be cared for by a team that performs hundreds of spine surgeries a year.
A spinal fusion is surgery, sometimes using growing rods, that joins, or fuses, some of the bones of the spine. These bones are called vertebrae. This procedure is sometimes used to treat scoliosis. Fusing the bones helps to prevent the curve from getting worse. It may not completely correct the curve.
There are three ways to do spinal fusions:
Anterior: done on the front part of the spine through an incision in your child’s side.
Posterior: done on the back of the spine through an incision in your child’s back. This is the most common.
Anterior-Posterior: done on the front and back part of the spine through two incisions.
All three methods use bone, metal rods and screws to fuse the backbones together.
The metal rods and screws help to keep the bones in the right place and hold them straight.
The bone graft acts as a bridge and grows into the spaces between the backbones, fusing them together.
The bone graft can come from either:
A piece of bone from your child’s own hip area—this is called an autograft. Your child will have another incision over his hip area.
A bone bank from someone who donated their bone—this is called an allograft.
The main goal of scoliosis surgery is to fuse the spine and keep the curve from progressing. The goal is not to completely straighten out the spine. In some instances, flexible curves that are fairly small can be almost completely corrected. In other cases, it can be dangerous or just not possible to achieve complete correction. Your child’s doctor will talk about the your child’s specific surgery goals.
Learn more about robotic-assisted scoliosis surgery
What are growing rods?
Growing rods allow for continued, controlled growth of the spine. They may be used to temporarily help with curve correction and to keep the curve from getting worse.
Your child’s surgeon attaches a metal rod to the spine, which can be lengthened over time during a series of outpatient surgeries as the child grows.
The rods attach to the spine at the top and bottom of the curve with hooks or screws. The surgery is done through the back of the spine, under general anesthesia (while your child is fully asleep).
Your child will need to return about every six months to have the rods surgically lengthened to keep up with the spine's growth. He may need to wear a brace. Once your child is older and the spine has grown, the doctor will remove the rods and perform a spinal fusion.
Vertical Expandable Prosthetic Titanium Rib Surgery
Children’s is one of the few pediatric hospitals in the country that performs vertical expandable prosthetic titanium rib (VEPTR) surgery. It can help children who have scoliosis and other spine conditions, such as thoracic insufficiency syndrome. Children with thoracic insufficiency syndrome cannot breathe normally. The condition causes severe deformities of the chest, spine and ribs. Almost all children with this condition also have scoliosis or other spinal problems.
How VEPTR works
The VEPTR is a curved metal rod. It is designed to help straighten a child's spine and separate the ribs for lung growth and improved breathing. The rod is made of titanium, which is a strong metal that is also able to stay in a child's body without rejection.
The device works by attaching the rods vertically from rib-to-rib or rib-to-hip bone, which allows it to expand as the child grows. For a child with scoliosis, the ribs are first separated during the initial implant procedure. Next, a VEPTR device will be attached from the top of the rib cage to the bottom of the rib cage. Another device will be shaped to fit from the top of the rib cage to the lumbar spine.
As your child grows, the rod expands. Eventually, your child will need surgery to further expand the rod and allow for more growth. When your child reaches maximum growth, you and your child’s doctor will discuss whether the device is still needed.
The surgery is recommended between the ages of 18 months and 5 years, but other ages may benefit.
After the surgery:
- Your child will stay in the hospital for two to five days
- The metal rod will need to be expanded every four to six months until your child stops growing
- Your child may be fitted for a thoracolumbar sacral orthosis brace (TLSO) brace to wear after surgery
- Your child can start being active in about a month
Image Guided Scoliosis Surgery
Spinal navigation is cutting-edge technology that your surgeon may use during surgery. Because spinal deformity is the core feature of scoliosis, better visualization using spinal navigation is a major step forward in the way this surgery is done.
- When using spinal navigation, your child will need to have a CT scan of his or her spine before the surgery.
- The CT scan is then loaded into a special navigation machine.
- During surgery, your child’s surgeon can "match up" landmarks on your child's spine that relate to those in the CT scan. Once this "registration" is performed, your surgeon can visualize your child's spine with an accuracy that is typically within 1-2 millimeters.
Additional surgery safety precautions
To improve the safety and accuracy of hardware placement, our surgeons use advanced equipment during the surgery, such as robotic-assisted or real-time navigation equipment. There are many other precautions that are taken during surgery to lower risks, including both cell saver and neurological monitoring.
Cell saver is a technology in which the blood that is typically lost during surgery is collected in a special container. The blood is then cleaned and filtered and can be transfused back. Although not all the blood that is lost can be used again, using the cell saver greatly lowers the risk of your child needing a blood transfusion from another person.
Neurological monitoring is utilized in all scoliosis surgeries. Once your child is asleep, a number of small needles are inserted in certain muscles all through the body. This allows the technologist to monitor your child’s spinal cord and nerve function during the surgery. If the monitor detects any changes, it warns your surgeon and anesthesiologist, and most issues can be easily corrected.