Anatomy of the Spine
The spine or backbone provides stability to the upper part of the body. It helps to hold your body upright. It consists of several irregularly-shaped bones called vertebrae appearing in a straight line. The spine has two gentle curves when seen from the side and appears to be straight when viewed from the front.
Spinal Curve Abnormalities
Spine deformity can be defined as abnormality in the shape, curvature, and flexibility of the spine. When the curves are exaggerated, pronounced problems can occur such as back pain, breathing difficulties and fatigue.
The different types of spinal deformities include:
- Scoliosis is a condition where the spine or backbone is curved sideways instead of appearing in a straight line. It curves like an “S” or “C” shape.
- Lordosis is a condition characterized by abnormal excessive curvature of the spine and is sometimes called swayback.
- Kyphosis is a condition where an abnormal curvature of the spine occurs in the thoracic (chest) region, resulting in the round appearance of the back.
Treatments of Spinal Abnormalities
There are different surgical approaches to repair these deformities and the choice of the approach is based on the type of deformity, location of the curvature, ease of access to the area of the curve and your surgeon’s preference.
Anterior approach
In this procedure, your surgeon will approach the spinal column from the front of the spine rather than through the back. The incision is made on your side, over the chest wall or lowers down along the abdomen, depending on the part of the spine that requires correction. The lung is deflated and a rib is removed to reach the spine. After the exposure of the spinal column, the disc material between the vertebrae involved in the curve is removed. Screws are placed at each vertebral level involved in the curve and attached to a single or double rod at each level. After instrumentation, a fusion is performed, where the bony surface between the vertebral bodies is roughened and a bone graft is placed. A combination of compression along the rod and rotation of the rod will correct the spine deformity. The incision is closed and dressed.
Posterior approach
This is the most traditional approach made through your back while you lie on your stomach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina and screws are placed in the middle of the spine. Then, a rod is bent and contoured to achieve a more normal alignment for the spine and is attached to correct the abnormality. After the final tightening, the incision is closed and dressed.
Anterior and posterior approach: This approach is used when the curve is stiff and severe. The first approach to the spinal column is made from the front. The incision is made on your side, over the chest wall or lowers down along the abdomen. Disc material between the vertebrae is removed. This procedure requires the removal of a rib, which is later used for bone grafting.
After the anterior procedure, the wound is closed and you will be positioned for the posterior approach. The incision is made down the middle of your back. Hooks are attached to the back of the spine on the lamina and screws are placed in the middle of the spine. Then, a rod is bent and contoured to achieve a more normal alignment for the spine and attached to correct the abnormality. After the final tightening, the incision is closed and dressed.
Video-assisted thoracoscopic surgery (VATS)
This is a minimally invasive technique performed using a small video camera. You will lie on your side. Four incisions of 1 inch each are made on the side of your chest wall. A thoracoscope, a thin instrument with a tiny camera and light at its end, is inserted through one of the incisions. The thoracoscope transfers images of the inside of the chest onto a video monitor, guiding your surgeon to perform the procedure. Retractor, suction and other surgical instruments are inserted through other incisions. Steps involved in the anterior approach are performed, which involves intervertebral disc removal, bone grafting, and instrumentation. The lung is deflated to gain access to the spine. The incisions are closed with an absorbable suture and the deflated lung is re-inflated.
