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Anterior Approach
Posterior Approach
Anterior and Posterior Approach
Minimally Invasive Approach
Recovery
Anterior Approach
What is it?
There are several different approaches that a surgeon will
use to correct spinal deformity such as scoliosis and kyphosis,
including the traditional posterior approach, an anterior
approach, or both. The anterior approach to scoliosis means
that the surgeon will approach the spinal column from the
front of the spine rather than through the back.
Technically speaking, the actual surgical incision and approach
to the spine is through the side of the chest or abdomen (stomach
area) rather than down the front of your body, as many patients
would envision it. The anterior approach allows surgeons to
remove discs from the front of the spine, place corrective
spinal instrumentation and perform a spinal fusion.
Why is it done?
The choice of an open anterior a pproach to the spine is based
on a number of different factors including the type of scoliosis,
location of the curvature of spine, ease of approach to the
area of the curve, and the preference of the surgeon. There
are certain types of scoliosis curves, such as those involving
the thoracolumbar spine, that are especially amenable to the
anterior approach. The surgeon may be able to fuse a shorter
segment of the spine using the anterior approach, preserving
more motion in the spinal column.
Anterior instrumentation techniques can produce very powerful
correction of spinal deformities. However, this approach is
more difficult than the standard posterior approach.
The Operation
The first thing that happens after you enter the operating
room is that your anesthesiologist will help you to fall asleep.
Once you are completely asleep, the anesthesiologist will
place a breathing tube to assist with your breathing during
surgery, establish a variety of catheters in your veins, and
often an arterial catheter in your wrist, all of which allow
for monitoring of heart function, blood pressure, fluid status,
and the depth of anesthesia during your operation. This allows
the anesthesiologist to be sure that you remain completely
asleep during the operation. Once this is completed, the patient
is rolled onto their side, with the operative side facing
up, into what is termed the "lateral decubitus position."
Incision:
The incision is made on the patient's side. Depending on the
part of the spine that requires correction, this may be over
the chest wall or lower down along the abdomen. The surgeon
deflates the lung and removes a rib in order to reach the
spine. Most patients find it interesting that the rib will
grow back over time, especially if you are young. For lower
incisions, the surgeon may need to detach the diaphragm to
gain access to the spine, especially for thoracolumbar curves
and those in the lumbar spine.
Spinal Preparation:
Once the surface of the spinal column is exposed, the surgeon
will often remove the disc material from between the vertebra
involved in the curve. This will increase the flexibility
of the curve and provide a large surface area for spinal fusion.
Disc removal is an important adjunct to the anterior correction
of scoliosis.
Screw and Rod Placement:
Placing instrumentation in the front of the spine completes
correction of the spinal deformity. This usually consists
of placing a vertebral body screw at each vertebral level
involved in the curve. These screws are then attached to a
single or double rod at each level. A combination of compression
along the rod, and rotation of the rod will produce correction
of the spinal deformity.
Fusion:
After the final adjustment and tightening of the instrumentation,
a fusion is performed. The bony surface between the vertebral
bodies is roughened and bone graft is packed into the space
between the vertebral bodies. There are a variety of different
sources for bone graft including the removed rib, the crest
of the pelvis, allograft bone, and other bone substitutes.
Incision Closure:
The incision is closed and dressed. If the surgeon has been
in the chest cavity, then it will be necessary to place a
chest tube through the side of the chest to help keep you
lung expanded after the surgery.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information. _________
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Posterior Approach
What is it?
There are different techniques and methods used today for
scoliosis surgery. The most frequently performed surgery for
idiopathic adolescent scoliosis involves posterior spinal
instrumentation with fusion. This kind of surgery is performed
through the patient's back while the patient lies on his or
her stomach.
Why is it done?
The Posterior approach was designed to correct the abnormal
curves in the spine that occur in the condition known as "scoliosis."
The posterior approach is the most traditional approach to
the spine for spinal surgery. The majority of spinal operations
are done using this approach.
The Operation
The first thing that happens after you enter the operating
room is that your anesthesiologist will help you to fall asleep.
Once you are completely asleep, the anesthesiologist will
place a breathing tube to assist with your breathing during
surgery, establish a variety of catheters in your veins, and
often an arterial catheter in your wrist, all of which allow
for monitoring of heart function, blood pressure, fluid status,
and the depth of anesthesia during your operation. This allows
the anesthesiologist to be sure that you remain completely
asleep during the operation. Once this is accomplished, the
patient is placed on their stomach and their arms and legs
carefully padded.
The Incision:
An incision is made down the middle of the back. The location
and length of the incision depend on the location of the curve
and the extent of the exposure that are required to correct
it. The incision is often made slightly longer than the length
of the planned fusion.
Hooks, Screws and Rod Placement:
Correction of the scoliosis requires that the surgeon be able
to "grab on" to the spine . There are a variety
of ways to do this. Technically, the surgeon may choose to
use hooks that attach to the back of the spine on the lamina,
pedicle screws that are placed into the pedicle in the middle
of the spine, wires, or other devices. Once these connection
points are established, then a rod that has been bent or contoured
into a more normal alignment for the spine can be attached
and correction performed.
Final Tightening:
When all of the implants are securely in place a final tightening
is done.
Incision Closure:
The incision is closed and dressed. Some surgeons may choose
to place a drain into the wound after the surgery to protect
the incision. Patients wake up in their hospital bed lying
on their back.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Anterior and Posterior Approach
What is it?
There are a variety of different approaches to correction
of spinal deformity. Surgeons make decisions regarding the
type of surgery that is appropriate for your case depending
on the type, severity, and location of your particular spinal
curve. In certain types of deformity, your surgeon may recommend
that you have what is termed a "front and back"
or anterior-posterior spinal surgery.
Why is it done?
Anterior and posterior surgery is generally recommended for
curves that are very severe, stiff, or when you have failed
previous attempts at fusion.
The Operation
The first thing that happens after you enter the operating
room is that your anesthesiologist will help you to fall asleep.
Once you are completely asleep, the anesthesiologist will
place a breathing tube to assist with your breathing during
surgery, establish a variety of catheters in your veins, and
often an arterial catheter in your wrist, all of which allow
for monitoring of heart function, blood pressure, fluid status,
and the depth of anesthesia during your operation. This allows
the anesthesiologist to be sure that you remain completely
asleep during the operation.
The Incision:
Anterior and posterior surgery requires that the surgeon will
first approach your spinal column from the front. In order
to do this, the surgeon will usually make an incision on your
side. The surgeon will then remove the disc material from
between the vertebrae in the most severe part of your curve
to make your curve more flexible and facilitate fusion. This
part of the procedure often requires removal of a rib that
is then used for bone graft.
After the anterior part of the procedure is
completed, the wound is closed and you are then positioned
for the "back" or posterior part of the procedure.
The deformity is then corrected with placement of spinal instrumentation
in your back followed by a posterior fusion.
 ________
Hooks, Screws and Rod Placement:
Correction of the scoliosis requires that the surgeon be able
to "grab on" to the spine. There are a variety of
ways to do this. Technically, the surgeon may choose to use
hooks that attach to the back of the spine on the lamina,
pedicle screws that are placed into the pedicle in the middle
of the vertebra, wires, or other devices. Once these connection
points are established, then a rod that has been bent or contoured
into a more normal alignment for the spine can be attached
and correction performed.
Final Tightening:
When all of the implants are securely in place a final tightening
is done.
Incision Closure:
The incision is closed and dressed. Some surgeons may choose
to place a drain into the wound after the surgery to protect
the incision. Patients wake up in their hospital bed lying
on their back. Most patients who have had anterior and posterior
surgery will require care in the Intensive Care Unit after
surgery.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Minimaly Invasive Approach
What is it?
The endoscopic system for scoliosis correction was designed
to allow the surgeon to accomplish all of the goals of a traditional
"open" anterior procedure, with much less trauma
to the muscles of the back and the rib cage. scopic anterior
scoliosis surgery is accomplished through the use of multiple
incisions or "portals" made in the side of the chest
cavity that allow the surgeon to insert instrumentation into
the vertebral bodies and perform a fusion. This procedure
is often referred to as being "Minimally Invasive",
because the surgeon uses several small incisions to perform
the surgery compared to a single longer incision. There are
several advantages of using an endoscopic system including
an improved visualization of the involved anatomy inside the
chest cavity, greater flexibility to place instrumentation
in the anterior aspect of the spine, and faster post-operative
recovery.
Why is it done?
scopic scoliosis surgery is not for everyone or every curve.
There are certain forms of scoliosis that are particularly
amenable to endoscopic correction, especially curves only
involving the thoracic spine. Lumbar and thoracolumbar curves
are better approached with a more traditional open technique.
The CD HORIZON® ECLIPSE™ Spinal System was designed
specifically for the endoscopic approach in the thoracic spine.
The Operation
The first thing that happens after you enter the operating
room is that your anesthesiologist will help you to fall asleep.
Once you are completely asleep, the anesthesiologist will
place a breathing tube to assist with your breathing during
surgery, establish a variety of catheters in your veins, and
often an arterial catheter in your wrist, all of which allow
for monitoring of heart function, blood pressure, fluid status,
and the depth of anesthesia during your operation. This allows
the anesthesiologist to be sure that you remain completely
asleep during the operation. Once this is completed, the patient
is rolled onto their side, with the operative side facing
up, into what is termed the "lateral decubitus position."
A special radio lucent operating table is used that allows
the surgeon to take x-rays during the procedure with a fluoroscope.
This is needed to make the incisions in the proper place and
at the correct level of the spine.
Microscopic surgery requires an accomplished surgical team
consisting of two operating surgeons, scrub nurses, monitoring
personal, and an anesthesiologist that is skilled in single
lung ventilation. All must work in concert to make the surgery
safe and efficient.
The Incision:
Three to five incisions are made depending on the location
of the scoliosis curvature, number of levels that will be
operated on and the ability to visualize the spine for the
safe placement of the spinal instrumentation.
Discs Removed:
The pleura is incised and retracted from the vertebral bodies.
Once the surface of the spinal column is exposed, the surgeon
will often remove the disc material from between the vertebra
involved in the curve. This will increase the flexibility
of the curve and provide a large surface area for spinal fusion.
Disc removal is an important adjunct to the anterior correction
of scoliosis.
Rib Graft:
Once all of the discs are removed, rib graft is harvested.
There is usually an adequate amount of bone graft that can
be harvested from the ribs. It is not necessary that the entire
rib be removed, so a normal contour to the chest can be maintained.
In certain situations where the ribs are very prominent, forming
a "rib hump", the ribs can be removed endoscopically
and improve the cosmetic outcome of the procedure. This is
known as a "Thoracoplasty".
Screw Placement:
Screws are placed in the anterior vertebral body under the
visual guidance of the endoscope and the fluoroscope. Once
all of the screws are in place, the disc space is filled with
bone graft.
Compression:
A rod, cut to length, is inserted into the chest cavity and
attached to the screws. Once the rod has been attached to
the screws, correction is accomplished by performing a compression
maneuver between the screws.
Closing the Incision:
The five small incisions are closed. Once healed the scars
are cosmetically small and less noticeable than a traditional
scoliosis scar. Since the surgeon was in the chest cavity,
a chest tube will often be used to keep the lung expanded
and healthy after surgery.
It is important that you discuss the potential risks,
complications, and benefits of CD HORIZON® ECLIPSE™
Spinal System with your doctor prior to receiving treatment,
and that you rely on your physician's judgment. Only your
doctor can determine whether you are a suitable candidate
for this treatment.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Recovery
As you prepare yourself mentally to undergo spinal surgery,
you also need to prepare yourself for the recovery period
that will follow your operation. While the surgery entails
work on the part of the surgeon, after that, the brunt of
the work is in your hands. To ensure a smooth and healthy
recovery, it is important that, as a patient, you closely
follow the set of instructions that your surgical team gives
you.
Hospital Recovery
After the operation, you will be brought to the recovery room
or intensive care unit (ICU) for observation. When you wake
up from the anesthesia, you may be slightly disoriented, and
not know where you are. The nurses and doctors around you
will tell you where you are, and remind you that you have
undergone surgery. As the effects of the anesthesia wear off,
you will feel very tired, and, at this point, will be encouraged
to rest.
Members of your surgical team may ask you to respond to some
simple commands, such as "Wiggle your fingers and toes"
and "Take deep breaths." When you awaken, you will
be lying on your back, which may seem surprising, if you have
had surgery through an incision in the back; however, lying
on your back is not harmful to the surgical area.
Prior to the surgery, an intravenous (IV) tube will be inserted
into your arm to provide your body with fluids during your
hospital stay. The administration of these fluids will make
you feel swollen for the first few days after the operation.
When you awake from the anesthesia, you may feel the urge
to urinate. So, in addition to the IV, a catheter tube (also
commonly called a Foley Catheter) will be placed into your
bladder to drain urine from your system. The catheter serves
two purposes: (1) it permits the doctors and nurses to monitor
how much urine your body is producing, and (2) it eliminates
the need for you to get up and go to the bathroom. Once you
are able to get up and move around, the catheter will be removed,
and you can then use the bathroom normally.
During your hospital stay, you will get additional instructions
from your nurses and other members of your surgical teams
regarding your diet and activity.
Proper nutrition is an important factor in your recovery.
Your surgeon may restrict what you drink and eat, or place
you on a special diet, depending on the surgical approach
that was used during the operation. Calories and food intake
are an important part of recovery. Some patients find that
their physician orders are less restrictive than the diet
they follow at home. After the surgery, you will continue
to receive intravenous fluids until you are able to tolerate
regular liquids, which typically involves gradually transitioning
you from sips of clear fluids to full liquids (including JELL-O®
gelatin). From there, you will be given small amounts of solid
food until you are ready to return to a regular diet.
With respect to physical activity, in most cases, your surgeon
will want for you to get out of bed on the first or second
day after your surgery. Nurses and physical therapists will
assist you with this activity until you feel comfortable enough
to get up and move around on your own.
Home Recovery
Before you are discharged from the hospital, your doctor and
other members of the hospital staff will give you additional
self-care instructions for you to follow at home - a list
of "dos and don'ts," which you will be asked to
follow for the first 6 to 8 weeks of your home recovery. So,
if you are unsure of any of these instructions, ask for clarification.
Following these instructions is crucial to your recovery.
Nowadays, surgery involves one or more incisions depending
on the surgical approach used to perform the operation. Therefore,
when you are discharged home you may still have a surgical
dressing on your incision(s). Either a nurse will visit your
home to change the dressing or a caregiver, such as one of
your family members, will be taught to do it for you. It is
important that the dressing be changed daily and kept dry.
If any signs of infection are observed while changing the
dressing, call your doctor. These signs include:
- Fever - a body temperature greater than 101°F (38°C)
- Drainage from the incision(s)
- Opening of the incision(s), and
- Redness or warmth around the incision(s).
In addition, call your doctor if you experience chills, nausea/vomiting,
or suffer any type of trauma (e.g., a fall, automobile accident).
During this recovery period, you will also be instructed
to keep your incision(s) clean, making sure only to use soap
and water to cleanse the area. In general, you should not
shower until your doctor has permitted you to do so.
In addition to caring for your incision(s), you will also
be encouraged to:
- Drink plenty of fluids
- Maintain a healthy diet (high in protein)
- Walk or do deep-breathing exercises, and
- Gradually increase your physical activity.
Activities to avoid include any heavy lifting, climbing (including
stairs), bending, or twisting. You should also avoid the use
of skin lotion in the area of the incision(s); you need to
keep this area dry until it has had the opportunity to heal
well.
Follow up with your doctor on a regular basis during this
post-operative period, and make sure to call your doctor if
you have any concerns or questions.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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