Spinal deformity correction
Correction of spinal deformity in Nagpur is a surgical procedure that aims at the correction of abnormal curvatures or deformities of the spine, such as:
1. Lateral curvature-scılösis
2. Forward curvature is known as kyphosis
3. Lordosis: convex inward curvature.
4. Spondylolisthesis (vertebral slipping)
5. Vertebral fractures or subluxations
The goals of a deformity correction of the spine include all of a following except:
1. Spinal alignment and stability
2. Relieving pain and discomfort
3. Improvement of the respiratory condition for the patients with extreme curvature
4. Improvement of the quality of life
Methods of surgical intervention in the modification of spinal deformity are:
1. Instrumentation with rods, screws, and plates
2. Osteotomy
3. Fusion
4. Vertebroplasty/Kyphoplasty
5. Spinal osteotomies
What Is a Spinal deformity correction?
Spinal deformity correction is surgery that is aimed at a correcting abnormal spinal curvatures or deformities, such as scoliosis, kyphosis, lordosis, or spondylolisthesis. It is essentially aimed at achieving a better alignment of the spine to improve the stability and function with the reduction of pain and discomfort and improvement in quality of life.
Therefore, correcting spinal deformity aims at
Restoring normal curvature of the spine
Rejection of abnormal spinal movement.
Fusion of vertebrae together, if necessary
Improvement in balance or correction of a spinal deformity or curvature.
In general, the procedure will include:
1. Incision and exposure of the spine
2. Placement of instrumentation devices, including rods, screws, and plates
3. Rectification of deformity with osteotomy, fusion, or some other methods
4. Closing the incision
Spinal deformity correction can be done to rectify terms like the following:
1. Scoliosis. It is lateral curvature.
2. Kyphosis. It is forward curvature.
3. Lordosis. It is inward curvature.
4. Spondylolisthesis. It is vertebral slipping.
5. Spinal fractures and dislocations.
Common Types of Spinal Deformities:
- Scoliosis: A lateral (side-to-side) curvature of the spine, often shaped like an “S” or “C.” It can be idiopathic (unknown cause), congenital, or neuromuscular.
- Kyphosis: An excessive outward curvature of the thoracic (upper) spine, resulting in a hunched and rounded back.
- Lordosis: An excessive inward curvature of the lumbar (lower) spine, also known as swayback.
- Spondylolisthesis: A condition where one vertebra slips forward over another, causing misalignment and possible spinal deformity.
Causes of Spinal Deformities:
- Congenital: Abnormal development of the spine before birth.
- Degenerative: Changes due to aging, such as disc degeneration or arthritis.
- Neuromuscular: Conditions like muscular dystrophy or cerebral palsy that affect muscle control and spinal alignment.
- Trauma: Spinal fractures or injuries that result in misalignment.
- Post-Surgical: Previous spinal surgeries may lead to imbalances in spinal alignment.
Symptoms:
- Visible Deformity: Abnormal curvature or appearance of the back or shoulders.
- Pain: Back pain, neck pain, or radiating nerve pain, depending on the severity of the deformity.
- Imbalance: Difficulty standing or walking upright, or uneven shoulders or hips.
- Breathing Difficulties: Severe deformities, especially in the thoracic region, can compress the lungs, causing breathing problems.
- Weakness or Numbness: Nerve compression from the deformity can lead to neurological symptoms, such as weakness or numbness in the limbs.
Diagnosis:
- Physical Examination: The doctor examines posture, spinal alignment, and range of motion.
- X-rays: X-rays help to visualize the extent of the spinal curvature and assess any structural abnormalities.
- MRI or CT Scans: These imaging studies provide detailed information about the discs, nerves, and soft tissues, especially if nerve compression is suspected.
- Cobb Angle Measurement: Used to quantify the degree of scoliosis curvature on X-rays.
Non-Surgical Treatments:
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- Bracing:
- Scoliosis Bracing: Custom-made back braces are used in children and adolescents with scoliosis to prevent further progression of the curvature as they grow. Bracing is less effective for adults.
- Bracing is worn for many hours a day and is typically used until the spine has finished growing.
- Physical Therapy:
- Exercises to strengthen the muscles supporting the spine and improve posture can help relieve pain and prevent further deformity progression.
- Postural Exercises: Strengthening core muscles, stretching, and maintaining proper alignment can alleviate symptoms.
- Medications:
- Pain Relievers: NSAIDs (Nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen may be prescribed to manage pain.
- Muscle Relaxants: These can help reduce muscle spasms.
- Epidural Steroid Injections: May be given to alleviate nerve pain caused by spinal deformity.
- Observation: In mild cases, the doctor may choose to monitor the deformity with regular X-rays to ensure it doesn’t progress, especially in younger patients.
- Bracing:
Surgical Treatment:
Surgery is considered for more severe spinal deformities, especially when they are causing significant pain, disability, or progressing rapidly. Surgical correction is aimed at realigning the spine, stabilizing it, and preventing further deformity.
Common Surgical Procedures for Spinal Deformity Correction:
- Spinal Fusion:
- This is the most common procedure for correcting spinal deformities. It involves permanently connecting two or more vertebrae to stabilize the spine. A bone graft is placed between the vertebrae, and over time, they fuse together.
- Instrumentation (Rods, Screws, Plates): Metal rods, screws, and plates are used to hold the spine in the correct alignment while the bones fuse together. This provides immediate stability.
- Osteotomy:
- In more severe cases, an osteotomy may be performed, where a portion of the bone is removed to allow for greater correction of the spinal alignment. This is commonly used in severe kyphosis correction.
- Vertebral Body Tethering (VBT):
- A newer, less invasive alternative to fusion, especially for scoliosis in growing children. It involves attaching a flexible cord (tether) to the spine, which allows for some movement while helping straighten the spine. This technique preserves more of a spine’s natural flexibility compared to fusion.
- Disc Replacement:
- In some cases, artificial discs can be used to replace damaged discs while maintaining mobility.
- Decompression Surgery:
- If the deformity is causing nerve compression, procedures like laminectomy or foraminotomy may be performed to remove part of the bone and relieve pressure on the spinal nerves.
Postoperative Care and Recovery:
- Hospital Stay: Most patients stay in the hospital for several days after surgery, depending on the complexity of the procedure.
- Rehabilitation: Physical therapy is usually required to help strengthen the muscles and improve mobility.
- Pain Management: Medications are used to manage postoperative pain.
- Activity Restrictions: Patients are advised to avoid strenuous activities, heavy lifting, and twisting movements for several weeks or months.
- Healing Time: Full recovery can take 6 months to a year, with regular follow-up visits to monitor progress.
Risks and Complications of Surgery:
- Infection: As with any surgery, there is a risk of the infection.
- Hardware Failure: Rods or screws may break or loosen over time.
- Nerve Damage: In rare cases, spinal nerves may be injured during surgery, causing weakness or numbness.
- Pseudoarthrosis: Failure of the bones to fuse properly can lead to continued instability and pain.
- Adjacent Segment Disease: Degeneration of the spine near the fused area can occur over time.
What procedures Spinal deformity correction?
The following are spinal deformity corrections:
1. Posterior Spinal Fusion- Fused through the posterior
2. Anterior Spinal Fusion-Combined procedure done anterior
3. Lateral Spinal Fusion-A procedure approached from the side or lateral
4. Minimally Invasive Spinal Fusion: Incisions made smaller and, depending on the case, some systems required specialized instrumentation for their insertion.
5. Scoliosis Correction-this is correction of the curved scoliosis deformity using instrumentation devices.
6. Kyphosis Correction-the curved kyphotic deformity is corrected using instrumentation devices.
7. Lordosis Correction : Instrumentation devices to reshape correct curves in the neck of lordotic curvature.
8. Spondylolisthesis Reduction : Instrumentation devices reduce vertebral slipping
9. Spinal Osteotomy : Cutting and realigning the spinal bones to correct deformity
10. Vertebroplasty / Kyphoplasty : The stabilization of vertebral bodies by strengthening to correct deformity
11. Spinal Instrumentation : Devices, including rods, screws, plates, and hooks that are used to stabilize and correct the spine
12. Ponte Osteotomy : A form of spinal osteotomy to correct scoliosis.
13. Smith-Petersen osteotomy: An osteotomy procedure that is intended for curving of the spine, especially targeting correction of kyphosis.
All of these operations are focused on the correction of deformities of the spine, which means restoring a normal spatial arrangement of the spine, and thus the quality of life.
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