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Fusions

Surgical techniques used to correct scoliotic spines are changing and evolving all the time. We’ve included a very brief overview of the most common approaches, with some descriptions and pictures to help illustrate some of the different techniques.

It is important to note that this is not a complete list and that each method has its own variations.

It is also important to remember that different techniques are used / recommended for particular reasons - whether it’s the type of curve, the speed of the progression, the age and health of the patient, or the specific specialties of the surgeon. It is highly recommended that anyone considering surgery get at least two medical opinions in order to have enough information to consider all of the possible options before deciding which approach might be most suitable for them.

I want to thank the many internet sources that assisted me in my journey of researching and compiling this list over time. I would also like to thank the many friends and colleagues who helped me with additional information and images, including several Scoliosis warriors from Facebook who offered up their x-rays, as well as Nancy DL Heraty, Yoga teacher, Scoliosis specialist, and co-author with Elise Browning Miller of the wonderful book, Yoga for Scoliosis: A Path for Students and Teachers.

Most common surgical techniques:

1. Harrington Rod

Paul Randall Harrington (1911–1980) was an American orthopaedic surgeon best known as the designer of the Harrington Rod, the first device for the straightening and immobilization of the spine inside the body. Using metal rods and hook instrumentation, this surgery was used regularly in the 1960s and remained the gold standard for scoliosis surgery until the late 1990s. During this period, over one million people benefited from Harrington's procedure.

It is interesting to note that in 1963, Harrington stated, "Metal does not cure the disease of scoliosis, which is a condition involving much more than the spinal column”.

 Harrington Rod, Martha Carter 

Harrington Rod, Martha Carter 

2. Cotrel-Dubousset Method (CD)

The CD surgery, introduced in 1983 by French Doctors, Yves Cotrel and Jean E Dubousset, is a double-rod instrumentation that incorporates a complicated series of hooks together with a pair of cross-braced rods. The versatility of this implant provides the flexibility to create custom-made constructs according to the requirements of each particular curve pattern.

 Cotrel-dubousset Fusion, Jennifer Benn

Cotrel-dubousset Fusion, Jennifer Benn

Newer techniques:

3. Vertebral Body Tethering (VBT) and Vertebral Body Stapling

Vertebral Body Tethering (VBT) is a minimally invasive surgical technique in which pedicle screws are placed into the front of the vertebral bodies and attached to a flexible cable at the bend of the curve. The cable is tightened, which allows some immediate correction of the curve, as well as continuing improvement as the spine grows.

 Example of Vertebral Body Tethering (VBT)

Example of Vertebral Body Tethering (VBT)

Vertebral Body Stapling is a type of ‘internal brace’ that controls the uneven growth and progressive curvature of a young scoliosis spine. Stapling on the convex side through small incisions is a minimally invasive surgical procedure which works best for thoracic curves under 35°. The patient is usually braced for one month after surgery, then no restrictions.

 Example of Vertebral Body Stapling (VBS)

Example of Vertebral Body Stapling (VBS)

Along with the fact that the procedures are less invasive than earlier surgical techniques, there are other potential benefits to VBT and VBS including that the spinal growth and flexibility are preserved, the correction of the curve occurs during growth and patients generally have more mobility than after traditional fusion surgery.
 

4. Wedging Osteotomies of vertebral bodies

For this procedure, used for skeletally mature adolescents, the surgeons remove a wedge-shaped section of vertebra on the concave side of the curve, straighten the spine by bringing the two sections together, and maintain the correction with a temporary rod system. While the patient has the rod, a brace is worn and all activity is restricted. After 12 weeks, when the osteotomies are healed and the rod is removed, the spine can move normally again and the patient can resume normal activity.

https://www.spineuniverse.com/conditions/scoliosis/new-surgical-treatments-scoliosis-vertebral-body-stapling-wedge-osteotomies

 Diagram of Wedging Osteotomy

Diagram of Wedging Osteotomy

5. For Pediatric Scoliosis Surgery Technologies:  

a.) Vertical Expandable Prosthetic Titanium Rib Device (VEPTR®)

VEPTR uses instrumentation to attach one or two rods to the spine (with screws, hooks, and screws) or ribs (with special hooks and brackets) above and below a spinal curve.

During surgery, the doctor adjusts the VEPTR device to fit the child and then attaches it to the ribs near the spine. The device is expandable, and as the child grows, it may require another procedure to lengthen it through a small incision in the back. Sometimes it can even be done as an outpatient surgery.

 Example of Vertical Expandable Prosthetic Titanium Rib Device (VEPTR®)

Example of Vertical Expandable Prosthetic Titanium Rib Device (VEPTR®)

b.) Magnetically Controlled Growing Rods for Pediatric Scoliosis

The difference between a traditional growing rod system and a magnetically controlled growing rod (MCGR) surgery is that MCGR allows rod lengthening without general anesthesia and a surgical incision. Rather, MCGR allows the child to stay awake during rod lengthening while external magnets adjust the rods.

Benefits of this method include

  • No follow-up surgeries are required after the initial implantation surgery.

  • No need for anesthesia.

  • Reduced costs.

  • Reduced stress and anxiety for children and parents.

https://www.spineuniverse.com/conditions/scoliosis/pediatric-scoliosis-surgical-technologies-growing-rods-growth-guided-devices

 Example of Magnetic Growing Rods

Example of Magnetic Growing Rods

c.) Growth-Guided Devices for Pediatric Scoliosis

Growth-guided devices use instrumentation designed to correct the scoliosis while allowing the child to grow. Two rods are implanted on each side of the spine and then the rods are attached to screws or wires, called anchor points, along the spine. As the child grows, the spine elongates along the rod. Two common growth-guided devices are the Luque trolley and Shilla technique.

 Before, during and after X-rays of Growth Guided Device

Before, during and after X-rays of Growth Guided Device

 Comparison of different Growing Rod Constructs

Comparison of different Growing Rod Constructs