1st order
- Surgical therapy for scoliosis consists of stabilizing the spine with rods. The affected area is stiffened.
- Correction of adolescent idiopathic scoliosis using the technique of dorsal spondylodesis (vertebral body blocking/surgery to stiffen the vertebral bodies from the back (dorsal) side).
- Note: Magnetically distractable implants (“magnetically controlled growing rods”, MCGR) now allow non-invasive transcutaneous lengthening of the spine during the growth phase in “early-onset scoliosis (EOS)” and thus physiological spinal growth in addition to correction of the scoliosis.
Indications (scoliosis during growth age) according to the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment 2012.
- > 10° Cobb angle* : clinical and radiological follow-up observations.
- 10°-20° Cobb angle: additional physiotherapy.
- 20°-50° Cobb angle: additionally scoliosis orthosis,
- Thoracic spine > 50 ° Cobb angle; lumbar spine > 45 ° Cobb angle: surgery indication.
* Wg. Cobb angle see under scoliosis / medical device diagnostics“.
Attention. Infantile scolioses correct themselves spontaneously in 80% of cases and do not require therapy! Only the fibrous, progressive (advancing) scolioses often require therapy. Possible complications
- General surgical risks
- Necessity of foreign blood
- Malposition of pedicle screws (medial position of one or more pedicle screws) → neurological risks.
- Neurological deficits in the context of scoliosis correction.
- Injuries to the dura, spinal cord, and nerves with paraplegic lesion with incontinence (inability to retain urine), hypoesthesia, dysesthesia, paresthesia (sensory disturbances), pallesthesia disorder (vibration sensation), or hyperpathia (hypersensitivity to sensory stimuli)
- Paresis risk (risk of paralysis).
- CSF leaks (leakage of cerebrospinal fluid (CSF) from the CSF spaces) with possible CSF fistula.
- Pleural injuries (thoracic injury) requiring chest drainage (drainage system used to drain fluids and/or air from the thorax)
- Vascular injuries with secondary bleeding
- Respiratory infection
- Urinary tract injury
- Intestinal atony (“intestinal paralysis”) with subileus (precursor to ileus) and ileus (intestinal obstruction), as well as subsequent operations
- Pulmonary complications (1-18%) – In one study, 82 of 703 patients (= 11.8%) had pulmonary complications postoperatively: Pleural effusion (accumulation of fluid in the pleural cavity, the narrow gap between the pleural leaves) (39 patients), pneumonia (pneumonia) (33), pneumothorax (accumulation of air next to the lung; life-threatening depending on severity) (3), respiratory failure (3), hematothorax (accumulation of blood in the pleural space) (2,) pulmonary edema (accumulation of water in the lungs) (1), and pulmonary embolism (pulmonary artery embolism; occlusion of a pulmonary artery by a thrombus (blood clot)) (1); pulmonary embolism was fatal.
- Wound healing disorders and wound infections.
- Risk of infection
- Failure of a bony fusion (“fusion”) of a spinal segment.
- Risk of loosening of implants
- Restricted mobility in the stabilized segment; possibly postoperative immobilization with an orthosis (here: medical device used for stabilization, relief, immobilization of the trunk/spine).
- Follow-up operations, e.g. due tobreakage of screw or rods.
Note: Postoperatively, pulmonary function may be reduced up to 60%. Further notes
- Correction of adolescent idiopathic scoliosis using the technique of dorsal spondylodesis (vertebral body blocking/surgery to stiffen the vertebral bodies from the back (dorsal) side): In the group of operated scoliosis patients, after 5 years, the level of general activity was higher than in the non-operated patients and similar to the controls.
