Hi. I'm Dr. Zach Tempel, a neurosurgeon at Mayfield Brain & Spine. For more than 80 years,
Mayfield has served our patients with superior, neuro-surgical care.
Today, I'd like to discuss how we diagnose and treat adult spinal deformity and scoliosis, two of
the most challenging spine conditions our patients will face. If you or a loved one suffers from
spinal deformity or scoliosis, you probably know that it can be painful, and even debilitating.
You should also know, that it's possible to ease your pain, and improve your quality of life.
At Mayfield, we are here as a partner to find the solution that serves you the best.
When evaluating patients with adult spinal deformity, I want to know the source of your pain,
and how you are living with it daily. This evaluation requires that we understand the
causes and effects of your spine condition. Not every patient with scoliosis or spinal
deformity needs to undergo a complex spinal reconstruction. If the underlying problem
is a disc herniation or instability at one or two levels, we can often help by performing a smaller,
more targeted operation. I suggest to patients considering spinal deformity surgery that they
keep four things in mind: first, you should gather information and consider your options
before taking this step you should not sign up for deformity surgery on your first visit you will be
a patient for three months and it will take six months for you to put the operation in the rear
view mirror it can take up to a full year for you to achieve the maximum medical benefit of surgery.
Secondly, patients will need a support community to help. It is important to have
family members or loved ones present during an office visit if you are undergoing this
type of surgery. Those supporting you need to understand the magnitude of what lies ahead.
Third, smoking dramatically reduces the benefits you can expect from your surgery and the chance
for a successful outcome. If you smoke, we'd recommend that you stop, and we will provide
you with the resources to help you succeed. Fourth, all surgery carries an element of risk.
Experience tells us, that the intensive process of recovering from this kind of surgery causes
complications. The key is how efficiently we can manage these complications, so you realize the
benefits of the surgery. Once we do that you are ready to proceed with diagnosis and treatment.
The next, most important step, is a thorough diagnosis. We'll start with the test called a
myelogram, to help us understand the anatomy of your spine in three dimensions. In a myelogram,
a special dye is injected into the spinal canal, and an x-ray fluoroscope records the images formed
by the dye. We then will order a specialized CT scan and x-rays, to document your spine stability,
and how the curve is changing over time. We will take these x-rays while you are standing.
The final test is a bone mineral density test. If you have impaired bone quality,
we need to start treating it with medication or other interventions. We need to have your bones
as strong as possible before we perform a spinal reconstruction. During this period, most patients
will work with one of our physical medicine and rehabilitation specialists on issues related to
the deformity. These doctors, called physiatrists, help you manage your symptoms before surgery. We
may also have you work with physical therapists or chiropractors before surgery as well.
When we get to surgery, there are multiple approaches, based on your anatomy and spinal
alignment. If we can treat you with minimally invasive techniques, the surgery may be performed
in one day. If the treatment requires multiple approaches, or carefully cutting
through the bone in an open approach, we will perform the surgery in stages over two days.
Staged operations are the gold standard in major spinal deformity surgery.
Operating in this fashion minimizes blood loss, and reduces the length of time a patient spends
under anesthesia. Staged surgeries are generally performed with two surgeons, or with a surgeon,
and an experienced surgical provider. After the first stage, we ask that patients stand
up and walk around, to gauge their symptoms. We will then order a new set of scoliosis x-rays,
to look at the alignment. In some cases, the first operation will have achieved
such a robust correction, that we are able to perform less invasive surgery the second day.
I like to say that it takes a village to help a patient who has complex spinal
deformity surgery is only part of the process, and the rest is the recovery.
Recovery often starts in the Intensive Care Unit, where patients stay for three or four
days. From the ICU, patients are then transferred to a standard hospital room, and then perhaps to
a rehabilitation facility, where they benefit from continuing support while their body heals.
Physical therapy is likely to continue for several months. As I mentioned earlier, it can take up to
a year for patients to realize the full medical benefit from complex spinal deformity surgery,
but the rewards are significant, for the patient ,for the family, and for the surgical team.
When a patient who has been suffering from spinal deformity comes to Clinic,
with the ability to stand upright, seeing the renewed sense of movement and pride is
a truly emotional experience. As I often say to patients, this is a team sport and we are all on
the same team. If we stick to that philosophy, everybody wins. I hope this video has answered
some of your questions about complex spinal deformity surgery. If you would like more
information please contact Mayfield Brain & Spine at 513-221-1100 or online at mayfieldclinic.com.