New Surgical Approach Shows Promise In Scoliosis Treatment
Since the time Tricia Ann Vinson was first diagnosed with scoliosis in sixth grade, the condition had become increasingly painful and debilitating.
Vinson -- now 23 -- started with pain in her right shoulder blade, then pain in her lower back, and then constant back pain that began when she was pregnant. The pain continued after her son was born, forcing her to limit how much time she played with him and picked him up.
She decided to try an experimental surgery at the University of Michigan Health System, in which the curvature of the spine is corrected with a minimally invasive procedure. Initially, she was still in pain and had limited mobility after the surgery. But now, six months later, Vinson is a success story.
The surgery "has made a huge difference in my life," Vinson says. "Now I'm able to lift my son up to take him outside, to run around after him and not have the pain. It's helped me in so many ways, both physically and mentally."
While minimal access spinal surgery for scoliosis is still experimental and offered in a small number of medical centers, it eventually could revolutionize the way in which severe scoliosis is treated, says Frank La Marca, M.D., director of the Section of Spine Surgery in the U-M Department of Neurosurgery. He notes that the procedure holds many advantages over the traditional surgery for scoliosis, a major operation that causes significant muscle damage, long scars and blood loss.
"Only time will tell how well patients do, but so far our patients have been able to return to work much quicker, their post-operative course has been shorter and their post-operative pain has been less," he notes. "My hope is that this actually becomes the standard of care on a national scale in the future."
La Marca notes that very few people have scoliosis that is severe enough to require surgery, which typically involves a curvature of 45 degrees or more. Vinson's curvature, for instance, was about 50 degrees before her surgery. In adults, about one in every 10 above the age of 40 will have some degree of scoliosis, he says. Of those, one of every 10 may have severe enough cases that surgery is an option. And in children, about one in every 333 will have scoliosis, with three to five of every thousand requiring surgery.
Until recently, the only surgical options were spinal fusion, in which the curved part of the backbone is straightened with rods or screws, and small pieces of bone are put over the spine so that they can grow and fuse together; and instrumentation without fusion, which is sometimes performed in small children, in which metal rods are attached to the spine without fusing the vertebrae together.
While many patients have had success with such procedures, the negative effects can be great, La Marca says. Stripping the muscles off the spine to allow for the placement of screws and rods can weaken the back and lead to chronic back pain. The scars are long, and the blood loss can be significant, he notes.
The minimally invasive approach requires very small incisions in the skin and no stripping of the muscles; instead, surgeons maneuver their instruments between the muscle fibers.
This approach is made possible because of the advancing technology used in neuro-navigational techniques. At U-M, the surgeons use a technique for navigating the screws through a patient's spinal muscles that is similar to the system used when NASA navigates a robotic arm in space, La Marca says.
New biological materials, such as synthetic proteins, are used to enhance the fusion of the spine. Additionally, La Marca, his neurosurgery colleagues and researchers at the U-M College of Engineering are designing new technologies -- such as special operating tables -- that could help to correct spinal deformities even before the instrumentation of the surgery begins.