6 months ago in the April 5th, 2021 blog post I addressed the question I sometimes get asked after surgery by parents, families and caregivers:
“How much correction of the scoliosis did you get during surgery?”
This blog post I will try to explain why we don’t always
want 100%, or even 90% or 80% or 70% of the spine deformity.
The first step is to use optics of long-term outcomes,
specifically minimal discomfort and highest level of function for decades into
the future.
To start the discussion it is important when we talk about surgery
for scoliosis, is to understand the ways we evaluate spine deformity. In the below picture the 3 planes of analysis
are shown: coronal, sagittal and transverse/axial plane.
During surgery to make the spine “normal” we need to:
1.
Make the spine totally straight (when we look
from the front or back)
2.
From the side the spine should have the normal
“S-curve”
3.
Correct all the abnormal rotation
If we do all 3 things this means 100%
correction of the scoliosis, in all 3 planes (see below):
Interestingly, research studies over the last 10+ years,
using patient-reported outcome measures, have identified what matters the most
for highly-functioning, minimally-painful, long-term outcome:
Global coronal and sagittal
alignment (Aims #1 and #2)
Basically we want to put the head balanced over the pelvis. Notice
I didn’t say axial or transverse plane (Aim #3)
So, it is safe to say 100%
correction is NOT necessary for optimal outcome long-term.
We will talk more about this
topic in the next post.