Surgery for degenerative adult spinal deformity
There is no easy spine surgery case, but deformity cases are usually challenging as they require long and complex surgeries to resolve the patient’s pathology. At the Morgenstern Institute of Spine we have more than 25 years of experience in solving complex spine cases, including adult spine deformity and scoliosis.
The classic open surgery for spine deformity is a quite invasive surgery. Due to its invasiveness, the patient usually needs to stay several days in an intensive care unit (ICU), postoperative pain control becomes an important issue and it may take several weeks before the patient can be discharged from the hospital and sent home..
However, thanks to new technological developments, our treatment philosophy for scoliosis and deformity surgery remains the same as for any other spine ailments we treat: we use the most advanced, minimamally invasive surgical (MIS) techniques to resolve the patient’s ailment and take his pain away, while minimizing postoperatve pain which allows an early patient mobilization (with these MIS techniques deformity patients usually start walking between the 1st and 2nd postoperative day) and can be discharged from the hospital a few days after surgery.
Left image: pre-operative X-ray film showing a spinal deformity with a lumbar scoliosis with a Cobb angle of 40º. Note the patient’s lopsided posture with a clear asimmetry of both shoulders that are not in line. Right image: postoperative X-ray film showing a corrected spine after minimamally invasive surgery. The lumbar spine’s Cobb angle has now been corrected to 6º. Note how both shoulders are now in line and the patient’s straight posture in comparison to the left image.
At the Morgenstern Institute of Spine we used the most advanced surgical technology, like an intra-operative CT scan (O-Arm) and navegation systems and a cell-saver that allows the patient to get transfused his or her own blood, to guarantee the highest safety and precision standards during surgery.
Image showing Dr. Morgenstern during a deformity surgery using a navigation system (on the back right) and an intra-operative CT scan (on the back left).
Adult degenerative Scoliosis
Scoliosis is a deformity of the spine in the front (coronal) plane.
A scoliosis can be idiopathic (usually from birth or as an adolescent) or degenerative (it is acquired and progresses with age). Degeneration of the spinal disks occurs progressively in time (because of age, weight and/or activity/strain) and can lead the spine to deform over time ending up in a degenerative scoliosis (also called “de novo” because the deformity has developed from new), in comparison to a congenital or idiopathic scoliosis that appear from birth on or in an early age.
Left image: pre-operative X-ray film of a patient that underwent previous operations on the lumbar spine and developed a degenerative scolisosis of the lumbar spine with a Cobb angle of 40º. Note how the patient’s posture is bent to one side and her shoulders are not straight in line (red line). Right image: postoperative X-ray films after a minimally invasive surgical correction of her deformity with a Cobb angle now corrected to 2º. Note now how both shoulders are in a straight line (red line) after the spine has been straightened.
A degenerative scoliosis is a pregoressive deformity of the spine that often causes the patient the inability to walk straight. Furthermore, scoliosis can cause back pain that often increases during sleeping. The degeneration and deformity of the spine can also cause a nerve root to be impinged, leading to a radiating pain on one or even both legs.
Case example of a 66 years old patient with Parkinson’s disease and a degenerativa lumbar scoliosis with a Cobb angle of 40º that was causing an important spine deformity and did not allow her to walk straight. She udnerwent a minimally invasiva deformity surgery in 2 surgical stages that allowed a complete correction of her spinal deformity. The patient resumed walking 1 day after surgery and she was discharged from the hospital 4 days after surgery.
Anterior column reconstruction (ACR) for spinal deformity
When a spinal deformity is painful, surgery can be done to correct the deformity and primarily to remove the pain caused by the degenerative scoliosis.
At the Morgenstern Institute of Spine, we employ one of the most modern correction surgeries available called anterior column reconstruction (ACR). This surgery is usually performed in two stages at two separate days: in a first stage, interbody devices (cages) are inserted into the degenerated lumbar disk(s) with minimally invasive anterior and lateral approaches to the spine.
Left image: standing X-ray film showing a thoraco-lumbar degenerative scoliosiswit a lumbar Cobb angle of 56º. Middle image: standing X-ray film after anterior colum reconstruction (ACR) surgery. Note how the lumbar Cobb angle of the scoliosis is now reduced to 39º. Right image: standing X-ray film showing final correction of the scoliosis after the second surgical stage. Final lumbar Cobb angle is 18º and the spine has been almost completely straightened out.
In a second stage the scoliosis is usually corrected with percutaneous, minimamally invasive posterior approach WITHOUT the need of an osteotomy. Only the most severe, rigid adult degenerative scoliosismay may require an osteotomy (cutting and chiselling the spine’s bone) to allow the straightening of the spine.
At the Morgenstern Institute of Spine we use the most modern technology, like an intra-operative CT scan (O-Arm) and navigation, as well as cell-saver technology to be able to auto-transfuse the patient with his/her own blood, to achieve the highest safety and precision standards for the deformity surgery.
We employ these advanced minimally invasive techniques to solve the patient’s pathology and alleviate the patient’s pain while at the same time we are minimizing the stay at the ICU (most patients usually stay 1 day at the ICU, if at all), post-operative pain is minimized which allows an early mobilization (most patients usually start walking at the 1st or 2nd postoperative day) and achieve an early hospital discharge (usually 5 to 6 days after surgery) for the patient to go home.
A complex case example for an adult spinal deformity and scoliosis
Case example of an 80 years old patient with a stiff, degenerative thoraco-lumbar scoliosis with a Cobb angle of 56º that was causing her excruciating thoracolumbar back pain especially at night that required strong opioid pain medication and narcotics. She underwent a minimally invasive deformity correction surgery in 2 surgical stages. Her spinal deformity was corrected to a Cobb angle of 18º. She resumed walking the 2nd day after surgery and was discharged from the hospital the 6th day after surgery.
