Surgical Approach - Posterior - Anterior - What does it Mean?

Surgical Approaches and Procedures
The scoliosis spine specialist will choose the surgical procedure that best treats the patient's problem. Sometimes more than one surgery produces the most favorable results. The surgeon will present the pros and cons of the different procedures so the patient and their family can make an informed decision with his guidance. Choices include:

• Posterior approach (from the back)
  
• Anterior-posterior approach (from front and back)
  
• Anterior approach (from the front)
  
• Thoracoscopic surgery (VATS, Video-Assisted Thoracoscopic Surgery)
  
• Thoracoplasty (rib resection, rib removal)
  
• Osteotomies (bone removal)
  
• Hemivertebrae excision (partial or complete removal of a vertebra)
  
• Kyphosis surgery
  
• Flatback surgery
  
• Vertebral column resection

Posterior Approach (Back)
The posterior approach has been the gold standard for years and continues to be a surgical procedure applicable to most patients. The procedure usually involves implanting two metal rods (stainless steel or titanium) to correct the abnormal curvature. Sometimes more than two rods are needed. A combination of screws, hooks and wire may be used to anchor the rods to the spine. A spinal fusion procedure helps to weld the bone grafts and vertebral of the spinal column into a solid mass. Thoracoplasty involves rib resection (partial or total removal) to decrease the size of the rib hump caused by scoliosis. The rib bone can be used as a source of bone graft used in the fusion procedure. Today, with pedicle screw fixation, thoracoplasty is less commonly performed than previously.

• The posterior approach is usually required in patients with double or triple curves or curves associated with significant kyphosis.
• In younger patients and adults with satisfactory bone density (strength), bracing is not used after surgery.
• Posterior instrumentation (e.g. rods, screws) without fusion or "growing rods" can be performed in patients with juvenile or infantile scoliosis under age 10. Growing rods allow for straightening of the spine and subsequent lengthening procedures until the patient reaches adolescence when a final fusion procedure is performed.
• The average hospital stay for most operations ranges from four to seven days.

Posterior Approach - Scoliosis (below)

Before

After

Before

After

More Spinal Information

Scoliosis Surgery Goals
Adult Scoliosis Treatment Overview
Adolescent Idiopathic Scoliosis
Minimally Invasive Thoracoscopic Surgery for Scoliosis
Scoliosis Surgery Goals
Scoliosis X-rays and What They Tell Us

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For additional health information, please contact Scoliosis and Spine Associates at our Manhattan, New York City medical practice (212) 986-0140.