Adult spinal deformity surgery is reserved for a small subset of patients who have failed all reasonable conservative (non-operative) measures. They generally have disabling back and/or leg pain and spinal imbalance. Their functional activities are severely restricted and their overall quality of life has reduced substantially.
The goals of surgery are to restore spinal balance and reduce pain and discomfort by relieving pressure off the nerves (decompression) and maintaining corrected alignment by fusing and stabilizing the spinal segments. Surgical stabilization involves anchoring hooks, wires or screws to the spinal segments and using metal rods to link the anchors together. They act as a tether and allow the spine to fuse in the corrected position. Fusion is performed by using the patient’s own bone or using cadaver or synthetic bone substitutes. In more severe cases, spinal segments have to be cut and realigned (osteotomy) or entire segments may have to be removed prior to realigning the spine (vertebral column resection). There are many different types of surgical procedures designed to treat adult spinal deformities. A detailed description of each is beyond the scope of this discussion.
It is important to note that surgery in the adult deformity population is riskier than in the adolescent teenager. The complication rate is significantly higher and the recovery, a lot slower. Therefore, surgery should only be undertaken as a last resort and only after the patient has a clear understanding of the risks and benefits. All reasonable non-surgical measures should be attempted first. At the same time, when patients are carefully chosen and are mentally well-prepared for the surgery, excellent functional outcomes can be obtained which at times can be a positive life changing experience for a given individual patient.
Recent advances in surgical techniques include less invasive approaches by making smaller incisions as well as using biologic substances to accelerate the fusion process. Use of computer-assisted navigation systems and various forms of spinal cord and nerve monitoring may help in improving surgical precision and accuracy. Although promising, longer follow-ups are needed before one can conclude that they are superior to existing time-honored methods.