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Home > Adult Spinal Deformities (ASDs) – Part V – Surgical Treatments Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

Adult Spinal Deformities (ASDs) – Part V – Surgical Treatments Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

Jeffrey R. Carlson, MD CPEJeffrey R. Carlson, MD, MBA, CPE, FAAOS

Adult spinal deformities represent a complex clinical issue necessitating a comprehensive approach to management. In this series of articles, we’ve reviewed spinal anatomy, the underlying causes for ASDs, presenting symptoms, and conservative treatment modalities.  Let’s look at the surgical spine procedures that are employed to treat ASDs and then the recovery and rehabilitation required afterwards. 

Surgical Interventions

In the 20+ years that I have been performing spine surgery, the advances that I have witnessed in technology and instrumentation have been nothing short of astonishing. Advanced minimally invasive techniques, improved pain management and safer anesthesia have made outpatient same-day surgeries possible, with reduced surgical trauma, and faster recovery times for select patients with ASDs. The selection of surgical approach, instrumentation and procedure depends on factors such as curve magnitude, flexibility, sagittal balance, and whether the surgeon has the skill to complete the surgery needed.

 Decompression: Surgical spine decompression aims to alleviate nerve compression by removing herniated discs, osteophytes (bone spurs), or spinal ligament thickening (hypertrophic ligamentum flavum).  This may be accomplished through microdiscectomy or laminectomy. These are typically performed as outpatient surgeries.

Spinal fusion: Advanced spinal fusion surgical techniques, combined with instrumentation such as rods, screws, and interbody cages, stabilize the spine, correct deformities, and promote bony fusion. I often use biologic bony material or cadaver bone to jumpstart the fusion process and to promote union. Fusion of one to three levels will be performed as outpatient surgeries, more will typically be performed as inpatient surgeries.

Osteotomies: Complex spinal osteotomies and vertebral column resection allow for correction of severe deformities by strategically resecting or realigning vertebral segments. An osteotomy of the spinal vertebrae is removal of bone from the back of the vertebral arch to allow for the correction of the long curves of the spine.

Osteotomies that only involve a few vertebral levels may be done as outpatient surgeries; however the more wide-ranging osteotomies (thoracic to lumbar, for example) may require inpatient hospitalization for more intensive nursing care during the earliest stages  of recovery.  I specialize in complex spinal reconstruction and have treated many patients surgically for ASDs.

Postoperative Care and Rehabilitation 

Recovery and Rehabilitation are integral components of the treatment continuum for patients undergoing surgical correction of adult spinal deformities. Early mobilization (meaning getting the patient out of bed and moving right after surgery), effective pain management, and physical therapy (when appropriate during recovery) are essential for promoting spinal stability, restoring function, and minimizing complications. Clinical monitoring for wound healing and neurological issues is important during the postoperative period.

Most of my ASD patients will be sent home the same day to recover In the comfort and safety of their own home.  I will order nursing and Physical Therapy to come to the patient’s home to monitor their recovery before the patient returns to my office for their first follow-up visit in about 10-14 days.  Most patients will be given a brace to wear whenever they are standing, which may be removed when they are sitting or prone.  Patients are encouraged to move and walk as much as they can tolerate to build strength and stamina during this period.

At that time, the patient will have x-rays so that I can check their surgery and instrumentation, and to remove their staples or sutures.  Steri-strips will be placed over the incision site, and they should be left on until they fall off on their own.  Patients may be advised to continue wearing their brace for an extended period or they may be allowed to stop.  Depending on the extent of surgery, patients may be fully released from follow-up visits, or may be asked to return periodically for check-ups on their healing.

Physical Therapy will be an important part of each patient’s recovery.  My ASD patients will not immediately go into PT but will wait until their surgical soft-tissue trauma has fully healed, at about six weeks, although patients requiring more extensive surgery may need more time.

Physical Therapy will help ASD patients regain and build strength that has been lost through the long surgical and recovery period.  The therapists will also help to increase range of motion in patients and help to decrease inflammation, stiffness and swelling.  PT will be crucial for most ASD patients to fully realize fitness and mobility goals after extensive spine surgery.

In the long-term – ASD surgical patients will need to follow-up for periodic clinical assessments with radiographic surveillance to monitor spinal alignment, detect potential disease progression, and address late-onset complications, such as adjacent segment degeneration, which affects about 5-10% of those which spinal fusions.

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