Surviving Scoliosis SurgerySurviving Scoliosis Surgery

Rich Lehrer ~ CRT, ARRT, BS Ed.

Normal Normal SpineSpine

3 Types of Scoliosis3 Types of Scoliosis

• Congenital– born with it

• Idiopathic– grow into it typically in your teenage years

• Paralytic– neuromuscular weakness can cause progressive

deformity– asymmetric paralysis

Congenital ScoliosisCongenital Scoliosis

3 Types of Scoliosis3 Types of Scoliosis

• Congenital– born with it

• Idiopathic– grow into it typically in your teenage years

• Paralytic– neuromuscular weakness can cause progressive

deformity– asymmetric paralysis

The problem is…The problem is…

• Pain - back, buttock, other...

• SOB

• Leg numbness, weakness, difficulty walking

• Spinal Stenosis

• Bladder control

Types of CurvesTypes of Curves

Available TreatmentsAvailable Treatments• Do Nothing• NSAIDS• Exercise

– walking, yoga, stretching, swimmimg

• Epidural Injections• Bracing• Surgery

Reasons to Go AheadReasons to Go Ahead• Increasing pain

– back, rib, pelvis, abdominal

• Poor Pulmonary & Respiratory Function– Cor Pulmonale

• Progression of the curve– >90 degree always has some pulmonary

compromise

• Conservative treatments have not worked

Making The DecisionMaking The Decision

• This is NOT an emergency

• Is it really time? Why now?

• Disability benefits - LOA - vacation time

• Medical Insurance?

• Where will I recuperate?

• Will my family be OK?

• Best case and worse case scenario

98 Degrees

Goals of the SurgeryGoals of the Surgery

• Relieve Pain

• Improve neurologic & physiologic condition

• Minimize residual deformity

• Level Pelvic obliquity

• Center the head over the spine

• Restore normal contour to the spine

Restore normal contour

The Pre-Op ProcessThe Pre-Op Process

Preparing for SurgeryPreparing for Surgery• X-rays

• Cardiac workup - treadmill, EKG, Echo

• Autologous Blood Banking - iorn

• Vitamins, flu shot, good nutrition, wt. loss

• Exercise - walking, stretching, yoga…

• Pulmonary Function Study

• Quit Smoking

Types of Pre-op XraysTypes of Pre-op Xrays• Upright Scoliosis Series PA & Lateral

• Pre-op CXR

• Sidebending films

• CT Scan

• MRI - neurologic involvement

• Myelogram

Upright is bestSitting Non-supported

Upright Lateral in the

wheelchair

Sidebending Film

Out of Balance!Out of Balance!

SidebendingBe sure my pelvis

is flat before you shoot!

PulmonaryFunction Test

The Body Box

Pre-opCXR

Pulmonary CompromisePulmonary Compromise

The Surgical ExperienceThe Surgical Experience

Spinal Monitor

Through the Endoscope

Post - Op & RecoveryPost - Op & Recovery

In the ICUIn the ICU• Coming out of anesthesia

• Ventilator

• Cardiac monitor

• Morning portable CXR

• Neurologic signs monitored

• Standard Post-op care

Post-opDay 1

Back in a roomBack in a room• Coughing, deep breathing, and sitting up

• PCA

• PT fit you with your brace

• OT teach you how to walk

• Advance diet

• Areas of numbness and tingling

• Loose the tubes - Foley, IV, ...

Before & After

Before & After

Post Opcorrection

29 degrees

Home Again (Whew!)Home Again (Whew!)• Change in lifestyle - temporarily slower

• Exercise - walking, swimming, other physical therapy

• Brace for several months

• Shower Chair & Hand Shower

• Cordless phone - TV remote

• Back to work?

TLSO

The Equation for SuccessThe Equation for Success

Comprehensive Pre-op planning

+ Patient Education

+Patient Cooperation

+ a Positive Mental Attitude

An Excellent Surgical Result

Thank YouThank You

• Daniel Benson, MD• “Turk” Darrington• Diane Gums, RN

• Tony Seibert, Ph D