Scoliosis Surgery Techniques

Non-Invasive Scoliosis Treatment in NJ, NY, and CT

Our group has been in existence for over 60 years now. I’d like to take a moment to tell you what is new in the treatment of scoliosis and related spinal conditions and tell you about innovations that my team and I are in the forefront of. First, I’d like to talk to you about safety and really when patients come to us from all over the world, what the patients and the families care most about in addition to having their curvatures and their deformities corrected and I don’t like the word deformities but that is sometimes what the patients experience. They feel that their backs and their body shape is off and they really want that corrected but they also want to know that is going to be done safely. So part of what our main focus is in addition to the techniques for improving the patient’s backs and preserving their functions and getting them back to a full life is really how do we do so in a safe manner. One of the things that I’ve found through research, we’ve published this research is that it is important that the surgeon and the team that takes care of the patient with scoliosis in the operating room is a very experienced team that does a lot of these surgeries because those who do more surgery have lower complication rates and less the need for fewer re-operations of the patients than those who do less surgeries. My team and I have done thousands of operations over 22 years and I’ve operated mostly in New York, but around the world including Africa and the Middle East as well so this is very crucial.

Another area we focus on and more importantly is neurological safety. In other words, avoiding paralysis for our patients. We do this first of all by being experienced, by having a lot of experience in treating the most difficult of cases and we work with a two-surgeon team so in every case I do, except for the smallest operations, the majority of the surgeries we do we have two experienced surgeons working together so that the operation is more efficient and it’s more safe. It’s been shown to be more safe in various studies. We use spinal cord monitoring and monitoring of the individual nerves and we call this multi-modal spinal cord monitoring. We monitor the sensory tracks that pick up sensation in the skin and the motor tracks that are responsible for motion and strength in the legs and upper extremities. We stimulate every screw that we place so we place a screw in the spine and these are the anchors we use to correct curvatures. We stimulate them with an electrical current to make sure they’re encased with bone and the current that we pick up at the ankles is very high so it takes a great deal of current to go through the bone and that tells us that the screws are in good position, in addition to checking the screws through the anatomy that we use and also through x-ray. I’ve developed a new technique for placing screws that I believe is an even safer way because it follows the anatomy and allows the screw to be placed right along the corridor of the anatomy into the bone and into the pedicle. So these are very important areas. In addition, we are always striving to minimize blood loss. Patients don’t want blood transfusions, their families would like to avoid that, although the risk of blood transfusions is quite low, we still do our best to minimize that and we do that again, by having a two-surgeon team so that the operation becomes more efficient and we’ve done a lot of studies on operative efficiency. How do we make the operations go more smoothly and more quickly so that the patient is off the table sooner, has less anesthetic and less blood loss. We do that in addition to the efficiency, we use special medication called TXA and with colleagues I’ve done a multi-center study on the use of TXA and we’ve shown that really significantly cuts down on blood loss. We also lower blood pressure and we use very meticulous techniques so the bleeding is minimized. We also pay attention to the incision and to minimizing infection. We want the incisions to close beautifully without problems and so we use a plastic surgeon as a member of our team to close all of our cases in which surgery is done from the back of the spine and so working with two surgeons, using a plastic surgeon as a colleague in the procedures really helps to minimize wound complications and we think may also help in decreasing infection.

Treating Scoliosis with Anterior Scoliosis Correction

We want the incisions to close beautifully without problems and so we use a plastic surgeon as a member of our team to close all of our cases in which surgery is done from the back of the spine and so working with two surgeons, using a plastic surgeon as a colleague in the procedures really helps to minimize wound complications and we think may also help in decreasing infection. A last area in surgery that I’d like to discuss is and this is a question many patients and their families have, I see a lot of adolescent patients, many of them have stopped growing but they have a curvature, a scoliosis of let’s say 50 or 55 degrees. It may not be painful, it may not even bother the patient in any way. So the question is should the patient have the curve corrected now because we do know that curves do tend to progress over the course of a lifetime, gradually and steadily. Or should they wait until they have a lot of pain and a severe curvature and have it addressed as an adult, many years down the line? So we performed a study and presented this at Prague at the Scoliosis Research Society Meeting and we found that if surgery is delayed, the operations performed on the adult are longer, they take a longer amount of time, there’s more blood loss, more levels of the spine are fused and there are much higher complication rates. 25% versus only 5% in the adolescent patient, so this is another piece of information that we believe is helpful for our patients and their families as to make the decision about the appropriate timing of surgery. I’d like to talk a little bit about another area of surgery that has been near and dear to me and that is in the area of minimally invasive approaches for scoliosis. I have been fortunate to be one of a few surgeons around the world who has focused on minimally invasive techniques. We started doing this 20 or more years ago, in which we would go through the side using a video camera and a scope. We call this video-assisted thoracoscopic surgery and through small incisions and minimal dissection of the muscle, we’re able to place screws and correct the spine and the curvature of the spine. We’ve now taken this to a new level, instead of placing a rod and infusing the spine, we use a flexible cord. We call this VBT or anterior scoliosis correction and we’re able now to preserve flexibility, to preserve growth, and correct the spine almost fully in most cases. So this is a very exciting area and I believe we’ll represent a big part of the future of scoliosis, although study will be required and we will have to work in conjunction with the FDA to sort out the best indications for this procedure. The last area I’d like to talk about is outcomes. My team and I have a wonderful research team have spent a great deal of energy in understanding outcomes, that is the results that patients experience because after all, this is about our patients and we’ve looked at various outcomes. We’ve created 2 new questionnaires that really get to the bottom of what the patient is experiencing. One is the body image disturbance questionnaire. How do I feel about my body image? How does it impact me in my daily life? Another one is the Truncal Anterior Asymmetry Scoliosis Questionnaire, it’s called TAASQ. TAASQ gets at what the patient experiences, the waste line, their breasts and whether one is longer or shorter than the other, different sizes and these are questions patients and their families have posed to my team and I over the years. Finally, a very exciting area and I believe the future of outcomes, understanding, assessment and evaluation of a patient is really going to be the patient generated index in which patients design their own questionnaire. What are the 5 most important areas of their life that are impacted by their scoliosis? How much does each one of those aspects have to them? Then we can see what the impact of our surgery is in each one of those areas, and to me that is the ultimate. It’s really what the patient wants, it’s not what we think is right for the patient so it gets the family’s values and their child or adult patients. So these are some of the areas my team and I have been working on. We look forward to evaluating you or your family member and to counseling you and giving you your options and discussing some of these important areas of ongoing research and most importantly, clinical care for our patients and their families. Thank you.

My team and I have a wonderful research team have spent a great deal of energy in understanding outcomes, that is the results that patients experience because after all, this is about our patients and we’ve looked at various outcomes. We’ve created 2 new questionnaires that really get to the bottom of what the patient is experiencing. One is the body image disturbance questionnaire. How do I feel about my body image? How does it impact me in my daily life? Another one is the Truncal Anterior Asymmetry Scoliosis Questionnaire, it’s called TAASQ. TAASQ gets at what the patient experiences, the waste line, their breasts and whether one is longer or shorter than the other, different sizes and these are questions patients and their families have posed to my team and I over the years. Finally, a very exciting area and I believe the future of outcomes, understanding, assessment and evaluation of a patient is really going to be the patient generated index in which patients design their own questionnaire. What are the 5 most important areas of their life that are impacted by their scoliosis? How much does each one of those aspects have to them? Then we can see what the impact of our surgery is in each one of those areas, and to me that is the ultimate. It’s really what the patient wants, it’s not what we think is right for the patient so it gets the family’s values and their child or adult patients. So these are some of the areas my team and I have been working on. We look forward to evaluating you or your family member and to counseling you and giving you your options and discussing some of these important areas of ongoing research and most importantly, clinical care for our patients and their families. Thank you.