Spinal fusion surgery can sometimes be used to prevent curvature of the spine from progressing. When the operation is completed through the back, it is known as posterior spinal fusion surgery, and when completed through the chest, it is known as anterior spinal fusion surgery.
In spinal fusion surgery, the joints of the spine are replaced are replaced with bone grafts that eventually fuse into one solid mass of bone. This fusion occurs after surgery, as the spine heals. The goal of spinal fusion surgery in conditions like scoliosis and other spinal curvatures is to fuse several individual vertebra into one solid bone. This stops the spine from continuing to grow out of alignment.
In some cases, instrumentation is used in spinal fusion surgery. This can include surgical screws, hooks, or rods. These are inserted to help support the bones of the spine and can help to slightly straighten a curve. Some children may need to wear an external brace following spinal fusion surgery to help hold the bones in place as healing occurs.
Spinal fusion surgery, when done early, can help stop the progression of a serious spinal curvature. One problem with spinal fusion surgeries that are performed on children who are not done growing is that the outcome of these procedures is hard to predict. Since the spine is not done growing, it will continue to grow in areas that are not fused. This may result in twisting, rotation, or further curvatures of the spine, despite spinal fusion surgery.
Spinal fusion surgery is sometimes recommended for children with early onset scoliosis, but it is not appropriate for every child with this condition. One of the risks associated with spinal fusion surgery is thoracic insufficiency. This condition develops when spinal fusion surgery stops not only the growth of the spine, but also slows or stops the growth of the chest or thorax. The chest then cannot support adequate respiratory effort and breathing problems develop.
Older children who develop kyphotic curves that are progressive are sometimes treated with spinal fusion surgery and instrumentation using rods, screws, or hooks. Sometimes the curvature cannot be corrected manually without significant risk of damaging the spinal cord. In these cases, surgeons sometimes remove misshapen vertebrae to correct the kyphosis.
An osteotomy can also be used in some cases. This surgical procedure involves realignment of the spine by removing sections of the vertebrae.