Blog Topic:  “How much correction of the scoliosis did you get during surgery?” Part 2

11-3-2021

 

In the last blog post I presented the position that 100% correction of the three-dimensional spinal deformity is NOT needed for optimal painless, long-term function.

However, to create the ideal aesthetic or cosmetic appearance of the body, from shoulders to the hips, achieving >90% correction is probably what is needed to completely normalize the body symmetry, including correction of the chest or rib deformity.

This leads us to corollary questions of the original question:

Is >90% correction achievable?

Is it safe?

Is appropriate?

 

The aesthetic or cosmetic appearance of the body is impacted by the spinal alignment, ribs, and muscle development.  Hence, if complete normalization of appearance is desired, then all structures from the shoulder to the hips also need to be corrected.  In scoliosis surgery we only directly operate on and correct the spinal alignment.  The ribs and muscles which are attached to the spine are secondarily, passively or indirectly improved as the scoliosis is corrected and untwisted.

The next question we need to ask is if we want >90% correction: How much surgery, or additional procedures, are needed to get to >90% correction?  Performing more procedures takes additional surgical time, which means the patient is asleep under general anesthesia longer, and the wound is opened longer.  As the surgical time is extended there are increasing risks of complications, such a blood loss (and need for blood transfusions), surgical site or wound infections, neurological deficits, lung complications (due to thoracoplasties or cutting of the ribs), and on and on.

It is difficult to quantify the amount of risk additional procedures will add to a surgical procedure.  The amount of risk depends on which procedures, the number of them performed and patient medical issues/comorbidities.  As surgeons we constantly make judgements as to how to maximize correction/outcome and minimize complications.  It is not an easy, straightforward decision-making process.

 

 

As we do more and more procedures to correct the alignment (horizontal axis), the risk of complications per procedure gradually increases, and the amount of correction for each procedure declines.

This circles us back to is to the question: is it appropriate to achieve >90% correction.  If you cannot tell from my blog I don’t aim for >90% correction for most surgeries for most patients. I think this much correction being comparable to that old adage: A long run for short slide.  Most patients cannot tell between 70%, 80% or 90% correction, except by looking at the x-rays.

I prefer to focus surgically on long-term painless function with, ideally, no surgical complications and a rapid return to normal activities.

 

 

In the above case there was a significant deformity correction, from 81 degrees to 27 degrees, but it’s not perfectly straight.  However she is nicely balanced.

As you see she looks excellent with balanced shoulder and waist.

There is nice correction of her body alignment.

Should we have gone for 100% correction?  I think not……