Minimally invasive surgery to treat scoliosis in teenagers is now a "feasible option," according to Vishal Sarwahi, MD, Director of Spine Deformity Surgery at Montefiore Medical Center.
"This new procedure to correct curvature of the spine involves three small incisions in the back, as opposed to standard open surgery, which requires a two-foot incision in the back," said Dr. Sarwahi. "While there are significant technical challenges in the new procedure, it has proved as effective as open surgery and involves less blood loss during surgery, shorter hospital stays, relatively less pain and pain medication and helps patients become mobile sooner."
Dr. Sarwahi has performed seven of the innovative procedures, and published the first professional journal article in the world on the topic in the August, 2011 issue of Scoliosis (www.scoliosisjournal.com/).
Until now, children with scoliosis, who are mostly girls, have been treated with traditional open surgery, in which a surgeon opens up a large section of the back, separates many back muscles and then places rods, screws and bone grafts along the spine to straighten the curvature. Dr. Sarwahi accomplishes all of the above through three tiny incisions in the back.
When curvature of the spine is severe, patients with scoliosis experience back pain and problems with heart and lung function. Scoliosis affects 60,000 school-age
children in the United States, resulting in over 600,000 doctor visits. An estimated 30,000 children are braced, while 38,000 patients undergo corrective surgery, according to the National Scoliosis Foundation. Of these surgeries, 13,000 are in teenagers.
The best candidates for the new procedure are adolescents with a routine spinal curvature of 40-70 degrees, said Dr. Sarwahi, who followed the seven patients over two years.
Minimally invasive surgery has been performed on adults with lumbar scoliosis in recent years, and the "next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent scoliosis," said Dr. Sarwahi.
The technical challenges Dr. Sarwahi and his team were able to overcome in the new procedure for children are significant. The spinal curvature in adolescent patients is more severe (50-100 percent greater than in adults); the number of vertebra requiring fusion is generally higher (from 7-13 vertebra); radiation exposure is greater due to multiple x-rays required to help place screws in each of the vertebrae; and the spine is twisted into three planes, which makes surgery more complex.
The new, minimally invasive technique takes longer than open surgery, said Dr. Sarwahi, but he believes the time in the operating room will be reduced as the procedure is performed in greater numbers.
In the study of seven patients, the surgeons limited the technique to curvature of the spine that was less than 70 percent. The technique provided "similar deformity correction as a standard open posterior spinal fusion," said Dr. Sarwahi.
Montefiore Medical Center