For patients with a highly rigid curvature and a severe deformity, the surgeon may need to remove the disc from the front of the spine using an anterior approach. This can be an open incision or a minimally invasive surgery using a thorascope. Several discs may be removed in this procedure and bone grafts inserted into the disc space to restore the intervertebral height and facilitate the fusion of the vertebrae into one long piece of bone. If a young patient with a lot of growth left to occur has a posterior fusion alone then they can suffer from a complication known as ‘crankshafting’. This is where the front of the spine continues to grow in spite of the posterior fusion, causing an alteration in the posterior/anterior curvature. Anterior fusion prevents this complication from occurring and is a preferred technique in younger children.
Anterior Scoliosis Surgery
Back surgery for scoliosis utilizing the anterior method may also be preferred where the curvature exists mainly in the thoracolumbar region, specifically at T12-L1. The surgeon will make an incision in the lower chest and remove a rib (generally from the left side) to obtain access to the anterior spine. The discs are excised which reduces the rigidity of the spine, and screws are affixed to the vertebrae to be connected by a metal rod which provides the curvature correction. The surgeon then inserts the bone graft for fusion into the disc space and may use further instrumentation to hold it in place. The formation of a solid fusion can take between three and six months, and continues for up to twelve months in some patients. Regularly x-rays will be conducted to assess the success of the operation and to catch any potential complications early. Irritation of the surrounding tissues by the rod used for curvature correction is not common, but can occur, leading to the removal of the rod once fusion has occurred.
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Anterior scoliosis surgery has the advantage of generally requiring the involvement of less vertebral levels, thereby maintaining a higher degree of segmental motion in the spine. In the lumbar spine this can be particularly helpful in reducing the risk of arthritis development which is more likely with fusion below the L3 vertebral level. Anterior surgery for scoliosis can provide excellent cosmetic results an better reduction in curvature, but is only appropriate for the thoracolumbar region. Most scoliosis is present in the thoracic spine however, which requires alternative, posterior fusion surgery.