Surgical treatment of scoliosis (operation)


Operations on the spine are in the area of ​​complex and high-tech medicine and are possible only in specialized clinics, with the appropriate material and technical base and staff. Surgery gives positive results and significant relief from scoliosis patients, but nevertheless the case that the operation does not justify the imposed expectations. Therefore, the decision about the operation in each case must be taken very carefully and cautiously, passing a comprehensive examination and consultation with experienced professionals.

indications for surgery

    The main indications for surgery for scoliosis include:
  • progressive spinal deformity (with an angle of curvature of 40 degrees or more) in children, when not yet completed skeletal growth;
  • spinal deformity with an angle of 60 degrees or more;
  • strain, which put pressure on internal organs, primarily the heart and lungs, thereby disrupting their work;
  • a strong pain that can not be removed by conservative methods of treatment;
  • defect in appearance caused by the deformation of the spine.
It is believed that the most favorable time to operate is the time before the end of the growth of the spine. Operation in early childhood fraught with changes in the growth of the spine in a direction opposite to the original distortion that can cause a new strain. In adulthood, the operation, in most cases, carry out because of pain, degenerative change or desire to achieve a cosmetic effect.

Types of operations on the spine for correction of scoliosis

The operation on the spine, usually has several goals at once: stop the progression of deformation correction and stabilization of the spine, removing pressure on internal organs, the elimination of pain and spinal cord compression, removal of cosmetic defects. Correction of the deformation is carried out by fixation of adjacent vertebrae with metal. In this case the mobility of the spine, of course, is reduced. Metal staples remain in the patient's body forever. Most recently developed movable metal that can be used for the growing spine.
Appliances, tools and methodology of surgical treatment for scoliosis is constantly evolving. Development in France in 1984 and Kotrelem Dyubusse (Cotrel, Dubousset) metal structure, which reduces the amount of strain stabilizes the spine and affects the rotation of the vertebrae has become a new word in the surgical treatment of scoliosis. Before this technique was used Harrington (Harrington). These two methods are used most heavily, they became the basis for further development of spinal surgery. Below is a brief description of the operational methods used in this country and abroad.
The operation by the method of Harrington

The method of Harrington (Harrington)

The method of Paul Harrington became famous in the 60s of last century. The method is to use a metal structure, which consists of a rod and hooks, which roam freely and are attached to the back of the spine in the right places. Distractor rod mounted on the concave side of bending, fixing hooks on the articular process of thoracic and lumbar vertebrae. On the convex side of the curvature using a rod-contractor. The postoperative period is accompanied by the wearing of a plaster corset for up to two weeks. Subsequent to wear a special corset - from six months to a year.
Harrington method is the most simple and safe. The operation lasts about 3 hours. The degree of spinal deformity as a result of the operation is reduced by about 60% of the original. This value is approximately the same for other methods. Complete elimination of deformation is impossible because of the risk of spinal cord injury with a significant change in spine shape.
The operation by the method of Luc
The operation of the method Kotrelya-Dyubusse

Method Kotrelya-Dyubusse (Cotrel-Dubousset)

This method was developed in the 80s of last century, french orthopedic surgeons. One of its main differences from the Harrington technique is to abolish the need for prolonged postoperative wearing a corset. The principle of the method Kotrelya-Dyubusse based on the use of an implant consisting of a fixation rods and hooks. The bars give the desired bend and attach them to the vertebrae. The method is widely used around the world.

Method of Luke (Luque)

In 1973 the Mexican orthopedic Eduardo Luque started working on a system for the correction of the spine.This design is a combination of L-shaped cylindrical rod and wire fixation, which allows you to spread out evenly along the length of an element of correcting spinal deformity. Postoperative fixation of the cast in most cases, the use of an operational method of Luque is not required.
The operation of the method Tsilke

Method Tsilke (Zielke)

Correction of deformity and fixation of the result by this method is based on the compression and derotation of vertebrae. The design consists of several pairs of elements: two bars and two screws. This system allows to form a solid structure, which can be used to create a sufficient correction of the curvature correction terms. After the operation is necessary to wear a plaster Zielke corset with subsequent transition to a special locking corset, worn up to 10 months.
Distractor Kazmina

Native methods of surgical treatment of scoliosis

In addition to these techniques are used in our country and the construction of our countrymen - distracters Kazmin, Fishchenko, plate-Rodnyansky Gupalova, Gavrilova. Often, surgery to combat the effects of scoliosis is running, using techniques Chaklin.
Kazmina distractor is used to correct the curvature of the lumbar spine. Distractor is installed so that their ends, he rested in the transverse processes of the vertebrae and the iliac bone.
Dvuhplastinchaty endokorrektor Rodnyansky-Gupalova
Monoplate endokorrektor Rodnyansky-Gupalova
Common in our country endokorrektory Rodnyansky-Gupalova are of two types. Monoplate endokorrektor used in dysplastic thoracic scoliosis with a curvature angle of 30 to 50 degrees (Cobb) in the treatment of juvenile kyphosis, and vertebral fractures. Dvuhplastinchaty endokorrektor severe degrees of scoliosis is designed for surgical treatment of dysplastic thoracic scoliosis of grade 4, taking into account the curvature of more than 50 degrees (Cobb).
In the West, the surgical treatment of the spine is no longer a rarity. Elaborate tools and extensive practice of minimizing the failure rate and complications. European leader in the use of surgical treatment of scoliosis is considered to be Germany. In our country the situation is somewhat worse, and therefore need to choose carefully the clinic, it is advisable to talk not only with his future surgeon, but also with the operated patients. best clinic in Moscow, St. Petersburg and Novosibirsk. All of them are usually found in the research institutes of Traumatology and Orthopedics (NIITO). Operations on the scoliosis is very expensive. For example, the U.S. operation Kotrelyu-Dyubusse in 2009 was worth 250 thousand dollars. In our country the cost of the operation, of course, is many times lower, but the likelihood of complications is higher.

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